Risk Factors for Prolonged Length of Hospital Stay and Readmissions After Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass

Abstract

BackgroundLaparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB) are most commonly performed bariatric procedures. Laparoscopic approach and enhanced recovery after surgery (ERAS) protocols managed to decrease length of hospital and morbidity. However, there are patients in whom, despite adherence to the protocol, the length of stay (LOS) remains longer than targeted. This study aimed to assess potential risk factors for prolonged LOS and readmissions.MethodsThe study was a prospective observation with a post-hoc analysis of bariatric patients in a tertiary referral university teaching hospital. Inclusion criteria were undergoing laparoscopic bariatric surgery. Exclusion criteria were occurrence of perioperative complications, prior bariatric procedures, and lack of necessary data. The primary endpoints were the evaluations of risk factors for prolonged LOS and readmissions.ResultsMedian LOS was 3 (2–4) days. LOS > 3 days occurred in 145 (29.47%) patients, 79 after LSG (25.82%) and 66 after LRYGB (35.48%; p = 0.008). Factors significantly prolonging LOS were low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence to bariatric center. The risk of hospital readmission rises with occurrence of intraoperative adverse events and low oral fluid intake on the day of surgery on.ConclusionsRisk factors for prolonged LOS are low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence. Risk factors for hospital readmission are intraoperative adverse events and low oral fluid intake on the day of surgery.

Laparoscopic Gastric Plication versus Laparoscopic Sleeve Gastrectomy: An Up-to-Date Systematic Review and Meta-Analysis

“…Postoperative complications are considered as a distinct factor that affects length of hospital stay. However, recent trials have questioned this statement concerning hospitalization after bariatric procedures [ 50 ]. According to a retrospective analysis of 2629 patients submitted to LSG by Jakob et al [ 51 ], hospital stay beyond 24 hours is not obligatory, under the condition that there are no signs of bleeding and leak or symptoms of vomiting and nausea.…”

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

“…(2013*). Recent reviews have commented on the early postoperative dietary strategy . Patients should be allowed to start drinking clear liquids the night of surgery.…”

“…Utilizing continuous noninvasive measurements of fluid status, such as the PVI, stroke volume variation, or other technologies, results in less fluid administration during bariatric surgery than empiric calculations of volume requirements or by monitoring urine output . Administration of excess IV fluids can increase the rate of postoperative nausea and length of stay after surgery . To decrease the chances of preoperative dehydration, patients should be allowed to drink clear liquids up to 2 hours prior to surgery.…”

Is routine post-sleeve gastrografin needed? Profile of 98 cases

“…In their study that included 492 patients, their definition of prolonged hospital stay post-LSG was > 3 days. They found that 29.47% of all patients needed a prolonged stay [9]. So, and considering the 9.2% figure found in KFSH bariatric centre, the ALOS at KFSH is not unusual.…”