23-hour stay outcomes for laparoscopic Roux-en-Y gastric bypass in a small, teaching community hospital

Abstract

The goal of every surgery is a successful outcome with the shortest hospital stay. Morbidly obese patients with their myriad of comorbidities have confounded surgeons over the years, usually leading to an increased length of hospital stays after complicated surgeries. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has proven to be an effective treatment for the morbidly obese with a usual length of stay of 3 days. The purpose of this article is to review our experience with 23-hour stays for LRYGB over a 13-month period and to apply a recently published risk score to these patients. A single surgeon performed 173 bariatric surgeries of which 96 were LRYGB, the study group. The demographics of this group found the overwhelming majority were female, white, slightly older than the men but with a somewhat smaller body mass index (BMI). The ethnic breakdown was 67.7 per cent white, 22.9 per cent black, and 9.4 per cent Hispanic. The average for all patients was 41.7 years and the BMI was 49.25 kg/m2. Using the Obesity Surgery Mortality Risk Score, 62.5 per cent of our patients were low risk or Class A, 37.5 per cent intermediate risk or Class B, and none of our patients qualified as high risk or Class C. Our average patient score was 1.3. In terms of length of stay, 91 of the 96 patients (94.8%) were discharged within 23 hours of surgery without mortality or 30-day readmission. The remaining five patients (5.2%) had unexplained, sustained tachycardia and were re-explored on the first postoperative day laparoscopically. Three of these patients had negative explorations. One had a jejunojejunostomy revision and the other was found to have a small bowel injury, which was laparoscopically repaired. All five patients were discharged within the next 23 hours. All patients were discharged on a clear liquid diet and advanced to a regular diet over the next month. No diet intolerance was noted nor were any patients converted to an open operation. In conclusion, we have demonstrated that a comprehensive bariatric program in a small teaching community hospital can successfully perform LRYGB and discharge a high percentage of patients within 23 hours with a very low complication rate. We also believe the Obesity Surgery Mortality Risk Score will help bariatric programs to risk-stratify their patients preoperatively. This will contribute to decision-making and further inform patients of their risk as part of their education preoperatively.