Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
Obes Surg. 2019 Jun;29(6):1751-1755. doi: 10.1007/s11695-019-03757-z.
Early discharge after laparoscopic sleeve gastrectomy (SG) is common and safe, but two-thirds of patients are still hospitalized longer than 1 day. The purpose of this study was to evaluate factors associated with early discharge at a single institution with intention to discharge on postoperative day 1.
Retrospective review of preoperative, intraoperative, and postoperative factors was performed for all patients undergoing SG at an academic hospital between 2010 and 2016. The primary outcome measure was length of stay (LOS). Multivariate logistic regression was used to identify independent predictors of prolonged LOS.
A total of 367 patients undergoing SG were included. Two hundred eighty-seven (78%) were women and 294 (80%) were Caucasian. Mean age was 45.5 years and mean body mass index (BMI) was 48.7 kg/m2. One hundred twenty-three patients (33.5%) had a LOS ≤ 1 day. Compared to patients staying ≥ 2 days, early discharge patients had significantly lower BMI, creatinine, and American Society of Anesthesiologists class, were more likely to be White, married, have private insurance, and were more likely to have a morning start and no postoperative upper gastrointestinal (UGI) swallow study. Regression analysis demonstrated several independent predictors of prolonged LOS including institutional experience (OR 0.5, p < 0.001), case start time (OR 0.6, p = 0.04), and routine UGI swallow (OR 8.8, p < 0.0001) postoperatively.
LOS after SG is affected by multiple factors, including patient health, socioeconomic status, case order, and postoperative management. Optimization of these may allow for improvement in preoperative education and streamlined postoperative pathways, resulting in reduced LOS.
腹腔镜袖状胃切除术（SG）后提前出院很常见且安全，但仍有三分之二的患者住院时间超过 1 天。本研究旨在评估单一机构中与术后第 1 天出院意图相关的提前出院因素。
回顾性分析了 2010 年至 2016 年期间在学术医院接受 SG 的所有患者的术前、术中及术后因素。主要结局指标为住院时间（LOS）。采用多变量逻辑回归分析确定 LOS 延长的独立预测因素。
共纳入 367 例行 SG 的患者。287 例（78%）为女性，294 例（80%）为白人。平均年龄为 45.5 岁，平均 BMI 为 48.7kg/m2。123 例（33.5%）的 LOS≤1 天。与住院时间≥2 天的患者相比，提前出院的患者 BMI、肌酐和美国麻醉医师协会（ASA）分级较低，更可能为白人、已婚、有私人保险，更可能在早上开始手术且无术后上消化道（UGI）吞咽研究。回归分析显示，延长 LOS 的独立预测因素包括机构经验（OR 0.5，p<0.001）、手术开始时间（OR 0.6，p=0.04）和术后常规 UGI 吞咽（OR 8.8，p<0.0001）。
SG 后的 LOS 受多种因素影响，包括患者健康状况、社会经济地位、手术顺序和术后管理。优化这些因素可能会改善术前教育和简化术后流程，从而缩短 LOS。
