Same-Day Discharge after Laparoscopic Roux-en-Y Gastric Bypass: An Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database

Inaba, Colette S.; Koh, Christina Y.; Sujatha-Bhaskar, Sarath; Zhang, Lishi; Nguyen, Ninh T.

doi:10.1016/j.jamcollsurg.2018.01.049

Cited by 37 publications

(26 citation statements)

References 19 publications

(15 reference statements)

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“…For instance, Rebibo et al reported a cohort with a 40% increase in the readmission rate (from 4% to 5.6%) [23] and others observed an increase in the ER visit rate [24]. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data set, Inaba et al found a signi cantly higher morbidity (3.76% vs. 1.54%) and mortality rate (0.94% vs. 0.05%) when comparing same-day discharge to POD1 discharge [25]. Similarly, Morton et al discovered that an LOS of ≤1 day was associated with a signi cantly increased risk of 30-day mortality (OR 2.02) for RYGB patients [26].…”

Section: Discussionmentioning

confidence: 98%

Initial result of unselective implementation of enhanced recovery after surgery in a low-volume bariatric unit: a feasibility and safety study

Chiu

et al. 2020

Preprint

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BackgroundThe feasibility and safety of unselectively applying an enhanced recovery after surgery (ERAS) protocol in a low-volume bariatric unit were determined. MethodsWe retrospectively reviewed all patients undergoing bariatric surgeries under a single surgeon between January 2015 and December 2018. Our ERAS protocol initiated in January 2017 with all patients enrolled unselectively. For those receiving non-primary procedures or with BMI<32.5 kg/m2 were excluded from this analysis. Demographic features and all 30-day outcome measures, including operation time, length of stay (LOS), ER visits, readmissions, reoperations were collected and compared between the ERAS (2017–2018) and control (2015-2016) groups. Results One hundred eighty-four consecutive patients underwent bariatric surgeries during the study period. Of those fulfilling the inclusion criteria, 62 (40.8%) were treated before and 90 (59.2%) were treated after ERAS implementation. No differences in baseline demographics were found between the groups except ERAS group had more Roux-en-Y gastric bypass procedures (58.9% vs. 12.9%). A markedly reduced operation time (101 min vs. 147 min; p<0.001) and shortened LOS (2.6 days vs. 3.3 days; p<0.001) were observed, with significantly more ERAS patients achieving POD1 discharge (45.6% vs. 1.6%; p<0.001). There were no significant differences in terms of ER visits (2.2% vs. 8%), readmissions (1.1% vs. 4.8%) or total complication rates between the groups (5.5% vs. 9.7%). ConclusionUnselective ERAS implementation in low-volume units is feasible and safe, with significantly reduced operation times and a shortened LOS without increased complications.

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Section: Discussionmentioning

confidence: 98%

Initial result of unselective implementation of enhanced recovery after surgery in a low-volume bariatric unit: a feasibility and safety study

Chiu

et al. 2020

Preprint

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“…Others observed an increase in the ER visit rate as a result of shortening the target LOS [21]. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data set, Inaba et al found a signi cantly higher morbidity (3.76% vs. 1.54%) and mortality rate (0.94% vs. 0.05%) when comparing same-day discharge to POD1 discharge after RYGB [22]. In another review from a large prospective database, Morton et al discovered that an LOS of ≤ 1 day was associated with a signi cantly increased risk of 30-day mortality (OR 2.02) and a trend toward an increased risk of serious complications for RYGB patients [23].…”

Section: Discussionmentioning

confidence: 99%

Initial result of unselective implementation of enhanced recovery after surgery in a low-volume bariatric unit: a feasibility and safety study

Chiu

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The feasibility and safety of unselectively applying an enhanced recovery after surgery (ERAS) protocol in a low-volume bariatric unit were determined.Material and methods We retrospectively reviewed all patients undergoing bariatric surgeries under a single surgeon between January 2015 and December 2018. Our ERAS protocol initiated in January 2017 with all patients enrolled unselectively. For those receiving non-primary procedures or with BMI < 32.5 kg/m2 were excluded from this analysis. Demographic features and all 30-day outcome measures, including operation time, length of stay (LOS), ER visits, readmissions, reoperations were collected and compared between the ERAS (2017–2018) and control (2015–2016) groups.Results One hundred eighty-four consecutive patients underwent bariatric surgeries during the study period. Of those fulfilling the inclusion criteria, 62 (40.8%) were treated before and 90 (59.2%) were treated after ERAS implementation. No differences in baseline demographics were found between the groups except ERAS group had more Roux-en-Y gastric bypass procedures (58.9% vs. 12.9%). A markedly reduced operation time (101 min vs. 147 min; p < 0.001) and shortened LOS (2.6 days vs. 3.3 days; p < 0.001) were observed, with significantly more ERAS patients achieving POD1 discharge (45.6% vs. 1.6%; p < 0.001). There were no significant differences in terms of ER visits (2.2% vs. 8%), readmissions (1.1% vs. 4.8%) or total complication rates between the groups (5.5% vs. 9.7%).Conclusion Unselective ERAS implementation in low-volume units is feasible and safe, with significantly reduced operation times and a shortened LOS without increased complications.

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“…The first retrospective study by Morton et al published in 2014 found increased 30-day mortality in patients undergoing RYGB in an ambulatory setting compared to patients who stayed 2 nights (odds ratio: 13.02; P < 0.001). The second study of Inaba et al published in 2018 was based on the large MBSAQIP database (bariatric registry in the USA) comparing 319 patients undergoing primary RYGB with SDD to 9402 patients discharged on postoperative day 1 and also found more complications in the SDD group (1.31% vs. 0.84 %, p <0.001) [ 12 ]. Both previous articles concluded that RYGB without overnight stay is not safe.…”

Section: Discussionmentioning

confidence: 99%

“…However, several small prospective studies assessed SDD after SG using a strict selection of patients did not show increased morbidity and mortality [5][6][7][8][9][10][11]. The only available data about SDD after RYGB is from three retrospective studies with conflicting results regarding feasibility and safety [12][13][14]. To our knowledge, no prospective studies have been performed on the feasibility of SDD after a primary laparoscopic RYGB.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass Using Remote Monitoring

et al. 2021

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Background Shortening of hospital stay to 1 night has not affected the short-term safety of patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB). Whether the RYGB is feasible in an ambulatory setting (same-day discharge) without overnight hospital stay remains to be answered. We aimed to evaluate the feasibility of same-day discharge after laparoscopic Roux-en-Y gastric bypass (RYGB) using additional live video consultation and remote monitoring. Same-day discharge (SDD) was defined as surgery without postoperative overnight hospital stay. Methods This was a single-center prospective feasibility study in a selected group of patients undergoing a RYGB. Fifty patients undergoing a primary RYGB were selected and potentially treated following the SDD protocol. After SDD discharge patients were remotely monitored after surgery for 48 h using a medical device measuring vital signs three times a day. Video consultations were performed by a doctor twice a day for 2 postoperative days. Primary outcome was the success rate (%) of SDD. Secondary outcomes were emergency room presentations, readmissions, early complications (<30 days), and patient satisfaction. Results A total of 50 patients were selected for the SDD treatment protocol between June 2020 and November 2020. An SDD success rate of 88 % (44/50 patients) was achieved. Five patients (10%) presented at the emergency room, 2 of whom (4%) were readmitted because of a complication within 30 days after surgery. Overall, patients who followed the SDD protocol reported high satisfaction scores. Conclusion A RYGB with SDD can be considered feasible using remote monitoring for a selected group of patients. Graphical abstract

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Same-Day Discharge after Laparoscopic Roux-en-Y Gastric Bypass: An Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database

Cited by 37 publications

References 19 publications

Initial result of unselective implementation of enhanced recovery after surgery in a low-volume bariatric unit: a feasibility and safety study

Initial result of unselective implementation of enhanced recovery after surgery in a low-volume bariatric unit: a feasibility and safety study

Initial result of unselective implementation of enhanced recovery after surgery in a low-volume bariatric unit: a feasibility and safety study

Feasibility of Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass Using Remote Monitoring

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