Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA.
Obes Surg. 2022 Dec;32(12):3900-3907. doi: 10.1007/s11695-022-06303-6. Epub 2022 Oct 4.
Same-day discharge (SDD) after bariatric surgery is gaining popularity. We aimed to analyze the safety of SDD after Roux-en-Y gastric bypass (RYGB) and compare its outcomes to inpatients discharged on postoperative days 1-2.
We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the period 2015-2020. Patients who underwent primary laparoscopic RYGB and were discharged the same day of the operation (SDD-RYGB) and inpatients discharged on postoperative days 1-2 (In-RYGB) were compared. Primary outcomes of interest were overall morbidity, serious morbidity, readmission, reoperation, intervention, and mortality rates.
A total of 167,188 patients were included; 2156 (1.3%) SDD-RYGB and 165,032 (98.7%) In-RYGB. Mean age (SDD-RYGB: 44.5 vs. In-RYGB: 44.6 years), proportion of females (SDD-RYGB: 81.4% vs. In-RYGB: 80.6%), and mean body mass index (SDD-RYGB: 45.8 vs. In-RYGB: 45.9 kg/m) were similar between groups. Overall morbidity (SDD-RYGB: 11.3% vs. In-RYGB: 10.2%; OR: 1.2, p = 0.08), serious morbidity (SDD-RYGB: 3.1% vs. In-RYGB: 3%; OR: 1.03, p = 0.81), reoperation (SDD-RYGB: 1.4% vs. In-RYGB: 1.2%; OR: 1.16, p = 0.42), readmission (SDD-RYGB: 4.8% vs. In-RYGB: 4.8%; OR: 1.01, p = 0.89), and mortality (SDD-RYGB: 0.04% vs. In-RYGB: 0.09%; OR: 0.53, p = 0.53) were comparable between groups. SDD-RYGB had lower risk of 30-day interventions (SDD-RYGB: 1.1% vs. In-RYGB: 1.6%; OR: 0.64, p = 0.04) compared to In-RYGB.
Same-day discharge after RYGB seems to be safe and has comparable outcomes to admitted patients. Standardized patient selection criteria and perioperative management protocols are needed to further increase the safety of this practice.
减重手术后当天出院（SDD）越来越受欢迎。本研究旨在分析胃旁路手术（RYGB）后 SDD 的安全性，并与术后第 1-2 天出院的住院患者进行比较。
我们对 2015 年至 2020 年期间代谢和减重外科认证和质量改进计划数据库进行了回顾性分析。比较了行腹腔镜 RYGB 并在手术当天出院的患者（SDD-RYGB）和术后第 1-2 天出院的住院患者（In-RYGB）。主要观察指标为总发病率、严重发病率、再入院、再次手术、干预和死亡率。
共纳入 167188 例患者；其中 SDD-RYGB 2156 例（1.3%），In-RYGB 165032 例（98.7%）。两组患者的平均年龄（SDD-RYGB：44.5 岁 vs. In-RYGB：44.6 岁）、女性比例（SDD-RYGB：81.4% vs. In-RYGB：80.6%）和平均体重指数（SDD-RYGB：45.8 vs. In-RYGB：45.9 kg/m）相似。总发病率（SDD-RYGB：11.3% vs. In-RYGB：10.2%；OR：1.2，p=0.08）、严重发病率（SDD-RYGB：3.1% vs. In-RYGB：3%；OR：1.03，p=0.81）、再次手术（SDD-RYGB：1.4% vs. In-RYGB：1.2%；OR：1.16，p=0.42）、再入院（SDD-RYGB：4.8% vs. In-RYGB：4.8%；OR：1.01，p=0.89）和死亡率（SDD-RYGB：0.04% vs. In-RYGB：0.09%；OR：0.53，p=0.53）相似。与 In-RYGB 相比，SDD-RYGB 发生 30 天干预的风险较低（SDD-RYGB：1.1% vs. In-RYGB：1.6%；OR：0.64，p=0.04）。
RYGB 术后当天出院似乎是安全的，且与住院患者的结局相当。需要制定标准化的患者选择标准和围手术期管理方案，以进一步提高该治疗方法的安全性。
