Equivalent Peri-Operative Outcomes for Laparoscopic Roux-En-Y Gastric Bypass Patients Discharged on Post-Operative Day One.

Abstract

Previous studies have evaluated the safety of post-operative day one (POD#1) discharge after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Few studies, however, have evaluated the impact of a standardized POD#1 discharge pathway on peri-operative outcomes. This study aims to evaluate peri-operative outcomes after implementation of an enhanced recovery pathway for RYGB patients. Data from a prospectively maintained database identified 2,049 patients (pre-implementation n = 904; post-implementation n = 1,144) who underwent LRYGB between 2008 and 2016. The POD1 discharge pathway was implemented in July 2011. Patient demographics and outcomes before and after implementation of the POD1 pathway were compared using univariate analysis and propensity matching. A propensity-matched group of all patients (n = 714) and POD#1 candidates (n = 490) pre- and post-pathway implementation were analyzed. Successful POD#1 discharges were significantly increased after introduction of the pathway (54.3 vs 17.8%, p < 0.0001). The post-implementation groups demonstrated no differences in mortality, Emergency department (ED) visits, readmissions, reoperations, and major or minor complications. Early discharge after bariatric surgery has a significant impact on the cost effectiveness of surgery, patient comfort, potential reduction of medical errors, and exposure to hospital-acquired infections. Our results demonstrate that a standardized POD#1 discharge pathway can be safely implemented and in turn, reduce hospital LOS without negatively affecting peri-operative morbidity, mortality, ED visit, readmission, or reoperation rates.