Meeting News

Early hospital discharge safe for some bariatric surgery patients

Ali Aminian

Early release from the hospital was safe in certain patients who undergo bariatric surgery, according to research presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery.

Ali Aminian, MD, of the Cleveland Clinic, and colleagues said that the use of enhanced recovery after surgery (ERAS) pathways has led to less time spent in the hospital and better outcomes for patients who undergo bariatric surgeries. Aminian said they conducted the study to determine the viability of earlier releases for these patients.

“The study showed that implementation of enhanced recovery pathway with early discharge from hospital after laparoscopic bariatric surgery seems to be well tolerated and feasible in a considerable fraction of patients,” Aminian told Healio Gastroenterology and Liver Disease. “If patients are selected appropriately, early discharge does not lead to increased rates of early complications or readmissions.”

Aminian and colleagues analyzed data from 80,464 patients from the Metabolic Bariatric Surgery Accreditation and Quality Improvement Program 2015 dataset for their study. Patients released on postoperative day 1 (POD 1) after laparoscopic Roux-en-Y gastric bypass (n = 8,862) and laparoscopic sleeve gastrectomy (n = 31,370) were matched 1:1 with patients who underwent the same procedures but were released from the hospital on the second postoperative day (POD 2).

The researchers found that patients released on POD 2 after gastric bypass had higher all-cause morbidity (composite of 26 adverse events; 7.5% vs. 6.1%; P < .001), as well as a higher rate of 30-day reintervention (2% vs. 1.5%; P = .004) compared with patients released on POD 1.

In the sleeve gastrectomy group, patients discharged on POD 2 had higher all-cause morbidity (4.2% vs. 3.4%; P < .001), serious morbidity (0.4% vs. 0.3%; P < .001), 30-day reinterventions (1% vs. 0.6%, P < .001), and 30-day readmission (2.9% vs. 2.5%; P = .002).

The investigators said their findings show that early discharge is safe in a select group of bariatric patients without serious co-morbidities.

Aminian said health care facilities are already starting to implement ERAS programs for patients undergoing bariatric surgeries.

“Currently, some centers are involved in the national pilot program called the E.N.E.R.G.Y. (Employing New Enhanced Recovery Goals for Bariatric Surgery) program, which was designed and implemented by the American Society of Metabolic and Bariatric Surgery (ASMBS),” he said. “Many other bariatric programs use components of ERAS in their practice.” – by Alex Young

Reference:

Ardila-Gatas J, et al. Abstract P581. Presented at: Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery; April 11-14; Seattle, WA.

Disclosures: The authors report no relevant financial disclosures.

Ali Aminian

Early release from the hospital was safe in certain patients who undergo bariatric surgery, according to research presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery.

Ali Aminian, MD, of the Cleveland Clinic, and colleagues said that the use of enhanced recovery after surgery (ERAS) pathways has led to less time spent in the hospital and better outcomes for patients who undergo bariatric surgeries. Aminian said they conducted the study to determine the viability of earlier releases for these patients.

“The study showed that implementation of enhanced recovery pathway with early discharge from hospital after laparoscopic bariatric surgery seems to be well tolerated and feasible in a considerable fraction of patients,” Aminian told Healio Gastroenterology and Liver Disease. “If patients are selected appropriately, early discharge does not lead to increased rates of early complications or readmissions.”

Aminian and colleagues analyzed data from 80,464 patients from the Metabolic Bariatric Surgery Accreditation and Quality Improvement Program 2015 dataset for their study. Patients released on postoperative day 1 (POD 1) after laparoscopic Roux-en-Y gastric bypass (n = 8,862) and laparoscopic sleeve gastrectomy (n = 31,370) were matched 1:1 with patients who underwent the same procedures but were released from the hospital on the second postoperative day (POD 2).

The researchers found that patients released on POD 2 after gastric bypass had higher all-cause morbidity (composite of 26 adverse events; 7.5% vs. 6.1%; P < .001), as well as a higher rate of 30-day reintervention (2% vs. 1.5%; P = .004) compared with patients released on POD 1.

In the sleeve gastrectomy group, patients discharged on POD 2 had higher all-cause morbidity (4.2% vs. 3.4%; P < .001), serious morbidity (0.4% vs. 0.3%; P < .001), 30-day reinterventions (1% vs. 0.6%, P < .001), and 30-day readmission (2.9% vs. 2.5%; P = .002).

The investigators said their findings show that early discharge is safe in a select group of bariatric patients without serious co-morbidities.

Aminian said health care facilities are already starting to implement ERAS programs for patients undergoing bariatric surgeries.

“Currently, some centers are involved in the national pilot program called the E.N.E.R.G.Y. (Employing New Enhanced Recovery Goals for Bariatric Surgery) program, which was designed and implemented by the American Society of Metabolic and Bariatric Surgery (ASMBS),” he said. “Many other bariatric programs use components of ERAS in their practice.” – by Alex Young

Reference:

Ardila-Gatas J, et al. Abstract P581. Presented at: Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery; April 11-14; Seattle, WA.

Disclosures: The authors report no relevant financial disclosures.