Length of stay and impact on readmission rates after laparoscopic gastric bypass

Background: A decreased length of stay (LOS) is one of the many advantages of laparoscopic over open Roux-en-Y gastric bypass for the treatment of morbid obesity. However, the mean LOS after laparoscopic gastric bypass (LGB) ranges from 1.8 to 4.5 days. In addition, the LOS has tended to improve as bariatric programs have matured. With the use of a standardized perioperative care plan, we studied the effects of LOS on readmission rates in patients undergoing LGB in a new minimally invasive bariatric surgery program. Methods: All patients undergoing LGB between September 20, 2001 and April 5, 2004 were entered into a standardized perioperative care plan. All patient outcomes were entered into a prospective database. The discharge criteria included adequate oral intake and adequate pain control on oral medication. The reasons for patients staying >2 days were analyzed and documented. Results: A total 250 patients underwent LGB. Of these, 212 patients (84.8%) were discharged on postoperative day 2. The most common reason for a LOS >2 days was bleeding (42.1%), followed by nausea (26.3%), inadequate pain control on oral medication (15.8%), and various other reasons (15.8%). The mean LOS did not change with time (P = .19). Readmission within 30 days was significantly less in patients discharged by day 2 (1.9% versus 13.1%, P = .005). Conclusions: The LOS remained constant as our program matured. The vast majority of patients undergoing LGB who have an uncomplicated postoperative course were safely discharged home on postoperative day 2. Patients staying >2 days were more likely to be readmitted within 30 days of discharge.