Alam Warda, Wisely Justin, Nasser Hassan
Department of Surgery, Henry Ford Jackson Hospital, 744 W Michigan Ave, Ste 101, Jackson, MI, 49201, USA.
Surg Endosc. 2024 Dec;38(12):7563-7568. doi: 10.1007/s00464-024-11189-9. Epub 2024 Sep 17.
There has been a rising trend of outpatient bariatric surgery, particularly accelerated by the COVID-19 pandemic. The aim of this study was to evaluate the safety and outcomes of same-day discharge laparoscopic Roux-en-Y gastric bypass (LRYGB) using the MBSAQIP database.
In this retrospective study, the MBSAQIP was queried for patients undergoing non-revisional LRYGB between 2020 and 2021. Two cohorts were established: same-day discharge (SDD; length of stay = 0 days) and next-day discharge (POD1; length of stay = 1 day), with the latter serving as a control group. Univariate analysis and multivariate logistic regression were employed to compare outcomes between cohorts.
A total of 48,408 patients underwent LRYGB, with 1,918 (4.0%) SDD and 46,490 (96.0%) POD1. The two cohorts were similar in mean age (SDD 44.2 ± 11.3 years vs POD1 44.0 ± 11.3 years; p = 0.61) and female sex (SDD 83.8% vs POD1 83.1%; p = 0.43). However, the POD1 cohort had a higher preoperative body mass index (45.4 ± 7.3 vs 44.9 ± 7.3 kg/m2; p < 0.01). Preoperative anticoagulation and obstructive sleep apnea were more prevalent in the POD1 group. There was no difference in overall 30-day overall complication rates (SDD 2.0% vs POD1 2.3%; p = 0.51), reintervention, reoperations, mortality, and emergency department visits between the two cohorts. Readmissions were lower in the SDD cohort (2.9% vs 4.0%; p = 0.02), whereas the need for outpatient intravenous hydration was higher in the SDD cohort (6.7% vs 3.6%; p < 0.01). This finding remained significant even after adjustment for confounders.
Same-day LRYGB is safe and feasible, with comparable complication rates to next-day discharge. Notably, SDD is associated with lower readmission rate and higher need for outpatient intravenous hydration, possibly reflecting rigorous bariatric protocols and thorough patient follow-up. Further investigations are warranted to elucidate the selection criteria and optimize postoperative care for outpatient LRYGB.
门诊减肥手术呈上升趋势，尤其是在新冠疫情的推动下。本研究旨在使用MBSAQIP数据库评估同日出院的腹腔镜Roux-en-Y胃旁路术（LRYGB）的安全性和疗效。
在这项回顾性研究中，查询MBSAQIP数据库中2020年至2021年期间接受非翻修LRYGB的患者。建立了两个队列：同日出院（SDD；住院时间=0天）和次日出院（POD1；住院时间=1天），后者作为对照组。采用单因素分析和多因素逻辑回归比较队列之间的疗效。
共有48408例患者接受了LRYGB，其中1918例（4.0%）为SDD，46490例（96.0%）为POD1。两个队列的平均年龄相似（SDD组44.2±11.3岁，POD1组44.0±11.3岁；p=0.61），女性比例相似（SDD组83.8%，POD1组83.1%；p=0.43）。然而，POD1队列术前体重指数较高（45.4±7.3 vs 44.9±7.3kg/m2；p<0.01）。POD1组术前抗凝和阻塞性睡眠呼吸暂停更为普遍。两个队列的30天总体并发症发生率（SDD组2.0%，POD1组2.3%；p=0.51）、再次干预、再次手术、死亡率和急诊就诊率无差异。SDD队列的再入院率较低（2.9% vs 4.0%；p=0.02），而SDD队列门诊静脉补液的需求较高（6.7% vs 3.6%；p<0.01）。即使在对混杂因素进行调整后，这一发现仍然显著。
同日LRYGB是安全可行的，并发症发生率与次日出院相当。值得注意的是，SDD与较低的再入院率和较高的门诊静脉补液需求相关，这可能反映了严格的减肥方案和全面的患者随访。有必要进一步研究以阐明门诊LRYGB的选择标准并优化术后护理。
