American Surgical Association
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10. Optimizing Outcomes In Bariatric Surgery: Outpatient Gastric Bypass
Todd M. McCarty, MD*
Baylor University Medical Center, Dallas, TX (Sponsored by: Goran Klintmalm, MD, PhD)

OBJECTIVE(S): Roux-en Y gastric bypass (RYGB) is an effective treatment for severe obesity and one of the fastest growing surgical procedures in the United States.

METHODS:A single institution prospective database of patients undergoing outpatient laparoscopic (lap) -RYGB over a 3-yr period was reviewed. Study endpoints included hospital discharge within 23-hours, 30-day hospital re-admission rate, early (<30 day) and late complication rates and 30-day peri-operative mortality. Variables assessed included surgeon experience, patient demographics, cormorbidities, OR time, Roux limb pathway, intra-op steroid bolus and use of dexmetatomidine.

RESULTS:Two thousand consecutive outpatient lap RYGB patients were identified, and 84% (n=1669) were discharged within 23-hours. Of these, 1.7% (n=28) were re-admitted within 30 days. The overall early and late complication rates were 1.2% (n=24) and 4.3% (n=86), respectively. The 30-day mortality rate was 0.1% (n=2), and neither patient was discharged prior to death. Univariate analysis demonstrated surgeon experience (<200 cases), age (<56-yrs), BMI (<60), weight (400-lbs.), cormorbities (<5) and intra-operative steroid bolus as predicitve of successful outpatient discharge. Multivariate analysis revealed surgeon experience, cormorbidities, BMI and steroid bolus as predicitive variables.
CONCLUSIONS:These data suggest that outpatient lap-RYGB can be performed with acceptable peri-operative complication rates, hospital re-admission and mortality rates. Surgeon experience, careful patient selection and the use of intra-operative steroid bolus predicted optimal patient outcomes.

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