23-Hour/Next Day Discharge Post-Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Surgery Is Safe

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is well established, yet practice varies as to when patients should be discharged post operation. After noting that many LRYGB patients met our unit's discharge criteria sooner than anticipated, we implemented a policy of aiming for 23-h inpatient stay post LRYGB in January 2012. This retrospective study aimed to assess the safety of this policy. We reviewed data of all patients undergoing LRYGB at our unit from September 2010 to October 2013. We compared the lengths of inpatient stay, complication rates and re-admission rates of patients treated before and after the introduction of the 23-h length of stay policy. Of 161 LRYGB procedures, 38 patients (29 female) underwent LRYGB from September 2010 to December 2011 (pre-policy change) and 123 (107 female) underwent operation after this date (post-policy change). The two groups were similar in terms of mean age (46.5 vs. 46.7 years, p = 0.932), mean BMI (46.8 vs. 46.6 kg/m(2), p = 0.868) and median number of pre-operative comorbidities (3 vs. 3, p = 0.9). There were significant reductions in median length of inpatient stay (2 vs. 1 day, p < 0.0001), re-admission rate (21.1 to 6.5 %, p = 0.025) and complication rate (18.4 vs. 3.3 %, p = 0.004) after the policy change. There were seven complications pre-policy change: pulmonary embolus (n = 1), chest infection (n = 1), constipation and anal fissure (n = 1), umbilical hernia requiring operation (n = 2), adhesional obstruction (n = 1) and persistent food intolerance (n = 1). Post-policy changes, there were four complications: adhesional obstruction (n = 2), staple line bleeding (n = 1) and persistent dysphagia (n = 1). There were no deaths. Patients undergoing LRYGB can be safely discharged on the first post-operative day. This reduction in length of inpatient stay offers significant cost savings.