Predictors of delayed discharge after adolescent metabolic and bariatric surgery

Enhanced recovery after surgery (ERAS) protocols have shortened hospital stays following metabolic and bariatric surgery (MBS); however, a subset of adolescents still experience delayed discharge, and contemporary national data remain limited.

Evaluate the incidence, temporal trends, and predictors of delayed discharge following adolescent MBS.

Multicenter, national database study.

Retrospective cohort study utilizing the 2015-2024 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Adolescents (ages 10 to <20) undergoing primary minimally invasive vertical sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were included. Delayed discharge was defined as postoperative length of stay (LOS) >2 days. Temporal trends were assessed with Cochran-Armitage test. Multivariable logistic regression identified predictors of delayed discharge.

Among the 10,553 adolescents (85.9% SG, 14.1% RYGB), delayed discharge occurred in 713 (6.8%) patients and was more common after RYGB than SG (9.6% vs 6.3%, P < .001). Delayed discharge decreased significantly over the study period for both procedures (both P < .001). Independent predictors of delayed discharge included Asian race (adjusted odds ratio [aOR], 5.15; 95% confidence interval [CI], 3.11-8.22), Hispanic ethnicity (aOR, 1.83; 1.48-2.25), sleep apnea (aOR, 1.56; 1.26-1.94), and Black race (aOR, 1.34; 1.08-1.67). Robotic approach (aOR, .54; .36-.78), increasing age (aOR, .88/yr; .83-.93), and operative year (aOR, .89/yr; .86-.92) were associated with decreased odds of delayed discharge.

Delayed discharge after adolescent MBS is uncommon and declining. Several modifiable and nonmodifiable predictors were identified that inform preoperative risk stratification, targeted perioperative optimization, and discharge planning in this population.