Objectives
Evaluate the safety of FTS program in patients undergoing primary and revisional bariatric surgery; identify limiting factors for early discharge and predictive factors for readmission.
Methods:
Retrospective review of 730 consecutive morbidly obese patients who underwent bariatric surgery between January 2016 - December 2017. Fast track protocol was applied on all patients. Target discharge after one-night stay. The primary end point is length of stay. The secondary end points frequency of hospital contact after discharge, readmission and reintervention within 30 days.
Results:
Primary procedures (n=633); banded bypass (BRYGB, 79.3%), sleeve gastrectomy (10.7%), gastric band (4.7%), others (5.3%). Mean age (±SD) 44.32±11.26 years and mean BMI (±SD) 43.58±6.12 kg/m2. Revision procedures (n=97); gastric band to BRYGB (40.2%), or to adjustable BRYGB (39.2%), Mason to BRYGB (11.3%), Sleeve to BRYGB (4.1%), others (5.2%). Mean age (±SD) 47.22±9.1 years and mean BMI (±SD) 37.9±7.27 kg/m2.
Mean LOS in primary patients was 1.3±0.99 and 1.5±1.4 for revision. Successful discharge at one night or less was achieved in 650 cases (573 primary and 77 revision). After one-night discharge, incidence of contact to the hospital, readmission and reintervention were 23.9%, 5.9%, 1.9%, in the primary group and 31.2%, 13%, 5.2% in revisional group.
Conclusion
One-night discharge in FTS managed revisional procedures is safe compared to primary procedures. However, it is associated with higher readmission rates, although the post-discharge hospital contacts and surgical complications were not statistically significant different.