How safe is same-day discharge after laparoscopic sleeve gastrectomy?

Inaba, Colette S.; Koh, Christina Y.; Sujatha-Bhaskar, Sarath; Pejcinovska, Marija; Nguyen, Ninh T.

doi:10.1016/j.soard.2018.07.016

Cited by 40 publications

(28 citation statements)

References 19 publications

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“…It is important to note that presently, there exist limitations even to implementing ERAS for certain elective procedures. Large-scale analysis of 85,321 cases of laparoscopic sleeve gastrectomy (LSG) from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database by Inaba et al demonstrated that attempts at same-day discharge are associated with increased complications, readmissions, and reoperations compared to discharge on postoperative day one [2]. Similarly, Colvin et al found that benefits of ERAS are limited in patients undergoing complex hernia repairs as their study found no change in duration of stay [9].…”

Section: Limitations Of Erasmentioning

confidence: 99%

“…Similarly, Colvin et al found that benefits of ERAS are limited in patients undergoing complex hernia repairs as their study found no change in duration of stay [9]. It is thought that monitoring patients overnight not only allows providers to detect and provide early intervention for postoperative issues such as respiratory deconditioning, but also allows ample time for patient education on best practices after surgery [2]. Although length of stay has been an important measure in research of inpatient ERAS, some believe that ERAS in ambulatory settings should focus less on ERAS and more on pain management, early mobilization, and overall quality of recovery [3].…”

Section: Limitations Of Erasmentioning

confidence: 99%

“…Ambulatory surgery centers allow procedures that are traditionally performed on an inpatient basis to be conducted as same-day outpatient surgeries [1]. In doing so, ambulatory surgery centers represent a cost-effective element in modern surgical care that has the potential to improve both outcomes and patient satisfaction rates [1][2][3]. One of the caveats of outpatient surgery, however, is prolonged recovery time associated with the use of anesthetic techniques beyond local analgesia.…”

Section: Introductionmentioning

confidence: 99%

“…Implementation of ERAS guidelines has allowed institutions to decrease length of stay, rates of complications, and medical costs [4,5,11]. Of note, the integration of short-interval postoperative follow-up appointments and use of multimodal pain therapy into ERAS can help patients limit postoperative narcotic use [2]. These postoperative recovery protocols have been demonstrated to have good outcomes in elective inpatient surgery, and their use has been more recently successfully initiated at ambulatory surgery centers for procedures such as mastectomy with or without reconstruction, robotic prostatectomy, and thyroidectomy [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Maximization of Non-Opioid Multimodal Analgesia in Ambulatory Surgery Centers

Charipova¹,

Gress²,

Urits³

et al. 2020

Cureus

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Ambulatory surgery centers aid the healthcare system by not only providing a cost-effective option for delivery of care but also by helping to reduce overwhelming case volumes at inpatient facilities. While outpatient protocols have been designed for an increasing number of surgical procedures, the inpatient to outpatient transition of surgery remains limited by both procedure type and patient comorbidities. This limitation stems in part from the heavy emphasis on accelerated discharge following outpatient procedures, given that prolonged recovery time is associated with delayed turnover and increased nursing care demands. Since its inception, enhanced recovery after surgery (ERAS) has aimed to primarily reduce the disruption of physiologic homeostasis that occurs secondary to surgery. More recently, the aim of ERAS has evolved to help transition inpatient procedures to outpatient settings and may even be useful in more emergent cases. It should be noted, however, that outpatient surgery even in combination with ERAS is not the best option for all patients, and the use of ERAS protocols should be complemented with predictive assessments of patient risk. Beyond augmenting the efficiency of outpatient surgery, ERAS protocols, when used in eligible patients and especially when combined with regional anesthetic techniques, are effective in delivering opioid-sparing pain management while increasing overall outcomes and patient satisfaction rates.

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Section: Limitations Of Erasmentioning

confidence: 99%

Section: Limitations Of Erasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Maximization of Non-Opioid Multimodal Analgesia in Ambulatory Surgery Centers

Charipova¹,

Gress²,

Urits³

et al. 2020

Cureus

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show abstract

“…Subsequently, the studies evaluating the association between BMI and outcomes have been controversial. Several studies have reported that higher BMI increases the risk of complications and readmissions after ambulatory surgery 6‐8 . However, others could not confirm this association 9 …”

Section: Introductionmentioning

confidence: 99%

Finding the body mass index cutoff for hospital readmission after ambulatory hernia surgery

Rosero

Joshi

2020

Acta Anaesthesiol Scand

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Background The suitability of ambulatory surgery in obese patients remains controversial. This study aimed to investigate the “cutoff” value of body mass index (BMI) associated with increased likelihood of hospital readmissions within the first 24 hours of surgery in patients undergoing ambulatory hernia repair. Materials and Methods The study used data from the 2012‐2016 American College of Surgeons National Surgical Quality Improvement (ACS‐NSQIP). Cochran Armitage trend tests were conducted to assess progression in rates hospital readmissions across categories of patient BMI. The minimum p‐value method, Kolmogorov‐Smirnov goodness of fit tests, logistic regression, and receiver‐operating characteristic (ROC) curve analyses were used to investigate the cutoff of patient BMI indicative of increased likelihood of readmissions. Results A total of 214,125 ambulatory hernia repair cases were identified. Of those, 908 patients (0.42%) had an unexpected hospital admission within the first 24 hours after surgery. The readmission rates did not significantly increase across the categories of BMI. However, some of the reasons for readmission significantly differed by BMI category. Logistic regression analysis revealed no statistically significant association between BMI and hospital readmissions (odds ratio [95% Cl], 0.96 [0.91‐1.02] P = .179). An optimal BMI threshold predictive of an increased likelihood of hospital readmissions was not identifiable by any of the statistical methods used. Conclusions Although reasons for readmission differed by BMI category, there is no clear cutoff value of BMI associated with increased hospital readmission within the first 24 hours after surgery.

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Enhanced Recovery in Bariatric Surgery

Feng

Brethauer

2019

The ASMBS Textbook of Bariatric Surgery

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How safe is same-day discharge after laparoscopic sleeve gastrectomy?

Cited by 40 publications

References 19 publications

Maximization of Non-Opioid Multimodal Analgesia in Ambulatory Surgery Centers

Maximization of Non-Opioid Multimodal Analgesia in Ambulatory Surgery Centers

Finding the body mass index cutoff for hospital readmission after ambulatory hernia surgery

Enhanced Recovery in Bariatric Surgery

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