MSS859: INCIDENCE AND PREDICTORS OF DELAYED DISCHARGE BEYOND POSTOPERATIVE DAY 1 AFTER BARIATRIC SURGERY AT A MILITARY TREATMENT FACILITY
Michael T Olson, MD; Yun Beom Lee, MD; Brian Layton, DO; Pamela Masella, DO; Department of Minimally Invasive and Bariatric Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
Objectives: Enhanced recovery after surgery (ERAS) protocols and other standardized perioperative pathways have made same-day or postoperative day (POD) 1 discharge routine after bariatric surgery in most centers. We aimed to evaluate the incidence of delayed discharge and identify preoperative or perioperative factors associated with prolonged length of stay (LOS) at a military treatment facility.
Methods: We performed a retrospective analysis of consecutive patients undergoing Roux-en-Y gastric bypass or sleeve gastrectomy between 01/01/2023 and 01/01/2024 by two surgeons at our tertiary military treatment facility. Patients were categorized into two groups: LOS ≤1 day versus LOS >1 day. Demographics, preoperative comorbidities, operative characteristics, and perioperative measures were compared. Univariate and multivariate logistic regression models identified predictors of LOS >1 day. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported.
Results: A total of 122 patients were included: 58 patients (47.5%) with LOS ≤1 day and 64 patients (52.5%) with LOS >1 day. Mean age (46±12 versus 46±10 years), patient sex (female, 69.0% vs 81.0%), procedure type, and preoperative comorbidities were similar. Patients with LOS >1 day had significantly longer mean operative times (150±56 vs 123±44 min, p=0.004) and higher overnight (POD 0) antiemetic use (1.33±1.39 vs 0.52±0.71 doses, p<0.001). Mean POD 1 oral intake was lower in patients with LOS >1 day (522±386 vs 786±316 mL, p<0.001). Univariate predictors of LOS >1 day included operative time per minute (OR 1.01, 95% CI 1.004–1.020), overnight antiemetic doses (OR 2.08 per dose, 95% CI 1.42–3.23), <500 mL of oral intake through POD 1 (OR 3.40, 95% CI 1.24–9.66), hemoglobin decrease ≥2 g/dL on POD 1 (OR 3.39, 95% CI 1.30–10.02), and total hydromorphone use through POD 1 (OR 5.44, 95% CI 2.33–14.67). Multivariate analysis demonstrated independent predictors of delayed discharge were low oral intake through POD 1 (OR 3.40, 95% CI 1.24–9.66), operative time per minute (OR 1.013, 95% CI 1.003–1.025), and overnight antiemetic doses (OR 2.01, 95% CI 1.21–3.64).
Conclusions: Delayed discharge beyond POD 1 occurred in more than half of bariatric surgery patients at our military treatment facility during the study period. Key predictors include longer operative time, higher antiemetic requirements, and reduced oral intake through POD 1; consuming <500 mL (approximately 16 ounces) of fluids was the most significant predictor. These findings highlight targets for perioperative optimization to reduce extended hospital stays after bariatric surgery.