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Is Ambulatory Laparoscopic Roux-En-Y Gastric Bypass Associated With Higher Adverse Events?

Morton, John M. MD, MPH*; Winegar, Deborah PhD; Blackstone, Robin MD; Wolfe, Bruce MD§

doi: 10.1097/SLA.0000000000000227
Original Articles

Objective: To determine the impact of length of stay upon 30-day outcomes.

Background: It has been recommended the goal length of stay (LOS) after laparoscopic Roux-en-Y gastric bypass (LRYGB) should be 1 day to improve resource utilization. This study's aim was to assess LRYGB outcomes by LOS.

Methods: Data were obtained from the BOLD (Bariatric Outcomes Longitudinal Database) for 51,788 laparoscopic gastric bypass (LRYGB) procedures performed between 2007 and 2010. Logistic regression models were used to evaluate age, sex, race, body mass index, insurance status, comorbidities, and LOS as predictors for 30-day mortality, serious complications, and readmissions.

Results: Overall patient demographics were as follows: median age, 45 years; median body mass index, 46.3 kg/m2; % female, 78.6; % white, 77.8; % private insurance, 86.2; and % comorbidities more than 5 (39.1%). Overall, 30-day outcomes included mortality, 0.1%; serious complications, 0.5%; and readmissions, 3.8%. median LOS was 2 days, and the distribution of LOS was as follows [n (%)]: 0 (1.0), 1 (18.4), 2 (59.0), 3 (17.5), and 4 (4.1). Using the median LOS 2 days as reference, the logistic regression analysis revealed that ambulatory LOS of was significantly associated with increased risk of 30-day mortality (odds ratio: 13.02; P < 0.0001) as was LOS 1 day (odds ratio: 2.02; P < 0.0552). For LOS of 0 day, there was a trend toward an increase in the rate of 30-day serious complications (odds ratio: 1.9; P < 0.16). There was no significant trend between LOS status and 30-day readmission rates.

Conclusions: In this large, prospective, clinical database, LOS of 1 day or less for LRYGB patients was significantly associated with an increased risk of 30-day mortality and a trend toward increased risk of 30-day serious complications.

Efforts have been directed to limit laparoscopic Roux-en-Y gastric bypass (LRYGB) length of stay (LOS) to 1 day or less. A total of 51,788 LRYGB surgical procedures from the BOLD (Bariatric Outcomes Longitudinal Database) (2007–2010) indicated that ambulatory LOS was significantly associated with an increased risk of 30-day mortality (odds ratio: 13.02), and there was a trend for LOS of 1 day for increased risk of 30-day mortality (odds ratio: 2.02).

*Stanford University School of Medicine, Stanford, CA

American Society for Metabolic and Bariatric Surgery, Gainesville, FL

Scottsdale Bariatric Center, Scottsdale, AZ; and

§Oregon Health Sciences University, Portland, OR.

Reprints: John M. Morton, MD, MPH, Section of Minimally Invasive and Bariatric Surgery, Stanford School of Medicine, 300 Pasteur Dr, H3680, Stanford, CA 94305. E-mail:

Disclosure: There are no sources of funding. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.