The analysis divided patients into those discharged the same day as their surgery (a 0-day length of stay), patients discharged the morning after their surgery and within 24 hours of their initial admission (1-day length of stay), and 2-, 3-, or 4-day length of stays.
In a multivariate analysis that controlled for baseline clinical and demographic factors, patients discharged on day 0 had a statistically significant, 13-fold increased risk of 30-day mortality compared with patients discharged on day 2. Patients discharged on day 1 had a twofold increased mortality rate that fell just short of significance (P = .055). Patients discharged on day 3 had a 30-day mortality rate that was virtually the same as that of day 2 patients, while those discharged on day 4 had a greater than fivefold increased mortality rate that was significant. Dr. Morton ascribed this higher mortality rate in patients with a 4-day hospitalization to the increased number of postoperative complications in these patients that likely led to their prolonged hospitalization.
"I think there is an opportunity for faster discharge, but with these data routine ambulatory discharge is not warranted, because 13-fold increased mortality is just not acceptable," commented Dr. Titus Duncan, director of minimally invasive and bariatric surgery at the Atlanta Medical Center.
Dr. Morton said that he has received an educational grant from Ethicon Endo-Surgery, and he has received honoraria from and served on the scientific advisory board of Vibrynt. Dr. Duncan said that he received a teaching grant from Ethicon Endo-Surgery.