Prospective 30-Day Outcome Evaluation of a Fast-Track Protocol for 23-Hour Ambulatory Primary and Revisional Laparoscopic Roux-en-Y Gastric Bypass in 820 Consecutive Unselected Patients

Abstract

Results from validated national databases suggest that a 1-day length of stay (LOS) is not only unattainable in more than 20% of primary laparoscopic Roux-en-Y gastric bypass (LRYGB) operations, but it is also associated with an increased 30-day mortality risk. There are no published data regarding the feasibility and safety of 1-day LOS after revisional LRYGB. We reviewed 1 surgeon's experience after implementation of a 1-day fast-track protocol (FTP) in 784 primary and 36 revisional consecutive LRYGB patients. Patient demographics, comorbidities, preoperative laboratory values, diagnostic work-up, operative characteristics, LOS, 30-day outcomes, and patient satisfaction scores were prospectively collected in a deidentified registry. Predictors of longer hospitalization were assessed by univariate and multiple regression analysis. One-day LOS was accomplished in 71.9% primary and 58.3% revisional LRYGBs. Median LOS was 1 day for primary and revisional LRYGB and mean lengths of stay were 1.34 and 1.63 days, respectively. "Excellent" or "very good" satisfaction ratings were reported regarding the FTP education provided (95.3%), surgeon's accessibility (98.3%), and hospital care (86.5%). Only 0.34% of patients who had a 1-day LOS indicated that they would benefit from an additional in-hospital stay. In multivariate analysis, independent predictors of longer hospitalization included prolonged operative time, hemoglobin reduction, reoperation for primary LRYGB, and operative time for revisional LRYGB. A 1-day FTP can be successfully implemented in the majority of primary and revisional LRYGB patients regardless of preoperative patient characteristics without increasing the risk of 30-day morbidity, mortality, reoperations, readmissions, emergency department or outpatient fluid visits, or reducing patient satisfaction.