Baker Matthew T, Lara Michael D, Larson Christopher J, Lambert Pamela J, Mathiason Michelle A, Kothari Shanu N
Gundersen Lutheran Medical Center, La Crosse, WI 54601, USA.
Surg Obes Relat Dis. 2006 Jul-Aug;2(4):435-9. doi: 10.1016/j.soard.2006.02.006.
A decreased length of stay (LOS) is one of the many advantages of laparoscopic over open Roux-en-Y gastric bypass for the treatment of morbid obesity. However, the mean LOS after laparoscopic gastric bypass (LGB) ranges from 1.8 to 4.5 days. In addition, the LOS has tended to improve as bariatric programs have matured. With the use of a standardized perioperative care plan, we studied the effects of LOS on readmission rates in patients undergoing LGB in a new minimally invasive bariatric surgery program.
All patients undergoing LGB between September 20, 2001 and April 5, 2004 were entered into a standardized perioperative care plan. All patient outcomes were entered into a prospective database. The discharge criteria included adequate oral intake and adequate pain control on oral medication. The reasons for patients staying >2 days were analyzed and documented.
A total 250 patients underwent LGB. Of these, 212 patients (84.8%) were discharged on postoperative day 2. The most common reason for a LOS >2 days was bleeding (42.1%), followed by nausea (26.3%), inadequate pain control on oral medication (15.8%), and various other reasons (15.8%). The mean LOS did not change with time (P = .19). Readmission within 30 days was significantly less in patients discharged by day 2 (1.9% versus 13.1%, P = .005).
The LOS remained constant as our program matured. The vast majority of patients undergoing LGB who have an uncomplicated postoperative course were safely discharged home on postoperative day 2. Patients staying >2 days were more likely to be readmitted within 30 days of discharge.
与开放式 Roux-en-Y 胃旁路手术相比，腹腔镜 Roux-en-Y 胃旁路手术治疗病态肥胖症有诸多优势，住院时间缩短是其中之一。然而，腹腔镜胃旁路手术（LGB）后的平均住院时间为 1.8 至 4.5 天。此外，随着减肥手术项目的成熟，住院时间有缩短的趋势。在一个新的微创减肥手术项目中，我们采用标准化围手术期护理计划，研究了住院时间对接受 LGB 患者再入院率的影响。
2001 年 9 月 20 日至 2004 年 4 月 5 日期间所有接受 LGB 的患者均纳入标准化围手术期护理计划。所有患者的结局均录入前瞻性数据库。出院标准包括口服摄入量充足和口服药物疼痛控制良好。对住院时间超过 2 天的患者原因进行分析并记录。
共有 250 例患者接受了 LGB。其中，212 例患者（84.8%）在术后第 2 天出院。住院时间超过 2 天的最常见原因是出血（42.1%），其次是恶心（26.3%）、口服药物疼痛控制不佳（15.8%）以及各种其他原因（15.8%）。平均住院时间未随时间变化（P = 0.19）。术后第 2 天出院的患者 30 天内再入院率显著更低（1.9% 对 13.1%，P = 0.005）。
随着我们的项目成熟，住院时间保持稳定。绝大多数术后病程无并发症的接受 LGB 患者在术后第 2 天安全出院回家。住院时间超过 2 天的患者出院后 30 天内更有可能再次入院。
