Roux-en-Y gastric bypass is an effective treatment of severe obesity and one of the fastest growing surgical procedures in the United States.
Dr McCarty reviewed a single institution prospective database of patients undergoing outpatient laparoscopic Roux-en-Y gastric bypass.
The investigators assessed the database over a 3-year period.
Study end points included hospital discharge within 23 hours, and 30-day hospital readmission rate.
The investigative team also included early and late complication rates, and 30-day perioperative mortality as study endpoints.
The team assessed surgeon experience, patient demographics, comorbidities, and operative time.
In addition, roux limb pathway, intraoperative steroid bolus, and use of dexmedetomidine was assessed.
The team identified 2000 consecutive patients undergoing outpatient lap Roux-en-Y gastric bypass, and 84% were discharged within 23 hours.
| The use of intraoperative steroid bolus predicted optimal patient outcomes|
|Annals of Surgery|
Of these, the investigators noted that 2% were readmitted within 30 days.
The overall early and late complication rates were 2% and 4%, respectively.
The investigators found that 30-day mortality rate was 0.1%, and none of these patients were discharged before death.
Univariate analysis demonstrated surgeon experience of less than 50 cases, age, body mass index, weight as predictors of successful outpatient discharge.
The investigative team also found comorbidities, and intraoperative steroid bolus as predictive of successful outpatient discharge.
The team used multivariate analysis to reveal that surgeon experience, comorbidities, body mass index, and steroid bolus were predictive variables.
Dr McCarty's team concluded, “These data suggest that outpatient lap Roux-en-Y gastric bypass can be performed with acceptable perioperative complication rates, hospital readmission, and mortality rates.”
“Surgeon experience, careful patient selection, and the use of intraoperative steroid bolus predicted optimal patient outcomes.”