• Fahad Mahmood, Alistair J Sharples, Adriana Rotundo, Nagammapudur Balaji, and Vittal S R Rao.
• North Midlands Institute of Metabolic & Bariatric Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
• Obes Surg. 2018 Jul 1; 28 (7): 1924-1930.

BackgroundLaparoscopic Roux Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly performed bariatric procedures. Improvement in techniques and perioperative management of patients have resulted in shorter hospital stay and reduced overall costs. Many post-operative protocols aspire to post-operative day 1 discharge with studies showing reduction in length of stay without increasing complications. In this study, we investigate the factors predictive of early discharge at our high-volume bariatric centre.MethodsA retrospective review of all patients who underwent bariatric surgery (RYGB or SG) at a single centre between January 2013 and December 2014 was undertaken. Routine preoperative investigations were performed and patient discussed at bariatric MDT. Post-operative management was as per standard protocols. Demographic data, type of surgery and post-operative data (length of stay, complications, readmission, reoperations) were analysed. Statistical analysis was performed using SPSS.ResultsFive hundred six patients underwent RYGB (407 (80.4%)) or SG (99 (19.6%)). The mean preoperative BMI was 45.9 (range 33.3-80.6). The median length of stay was 1 day (range 1-214 days; interquartile range 1-2 days) for RYGB and 2 days (range 1-8 days; interquartile range 1-3 days) for SG. Two hundred sixty-eight (52.9%) patients were discharged on post-operative day 1. The type of surgery and preoperative BMI were the only significant factors predicative of day 1 discharge after surgery. Patients undergoing SG were 3.3 times more likely to stay longer than 1 day after surgery (p < 0.001). BMI < 50 is associated with day 1 discharge (p = 0.030).ConclusionEarly discharge, on post-operative day 1 appears to be safe and is not associated with a greater risk of readmission. Sleeve gastrectomy and a BMI > 50 are associated with an increased risk of failure to achieve day 1 discharge.

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