Enhanced Recovery After Surgery and next-day discharge after laparoscopic Roux-en-Y gastric bypass

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common bariatric procedure, but patients often experience extended inpatient stays. Given that Enhanced Recovery After Surgery (ERAS) protocols aim to expedite recovery and discharge, we sought to evaluate the impact of introducing an overnight short-stay unit with ERAS protocols, along with transfer protocols for patients requiring prolonged care.

We retrospectively reviewed prospectively collected data on LRYGBs performed between November 2017 and December 2020. Postoperative evaluations were conducted 16-21 hours after surgery. Patients were educated about potential complications and required to stay within 1 hour of a tertiary centre for 7 days. We analyzed descriptive outcomes including length of stay (LOS), 30-day emergency department (ED) presentations, and 7-day and 30-day readmissions.

Among the 439 patients, the postoperative day 1 discharge rate was 94.8%, and the day 2 discharge rate was 1.8%. A small proportion of patients (2.7%) required transfer for anticipated prolonged LOS, primarily for delayed intra-abdominal hemorrhage requiring reoperation (66.7%) and as a precautionary measure for technically challenging procedures (16.7%). Two brief admissions to the intensive care unit occurred, with no deaths. Overall, 45 (10.3%) patients presented to the ED within 30 days, 12 (2.7%) patients were readmitted within 7 days, and 18 (4.1%) patients were readmitted within 30 days. Gastrointestinal intolerance was the most common reason for readmission.

An ERAS protocol for LRYGB enabled safe next-day discharge for 94.8% of patients. Rates of ED presentation and readmission aligned with existing literature, supporting the feasibility of next-day discharge for appropriately selected patients. These findings contribute to the evidence base for optimizing postoperative care and enhancing patient outcomes in bariatric surgery.