Background

Bariatric surgery is highly safe and effective. However, postoperative complications may occur and there is a potential risk for hospital readmission. Several strategies have been used for prompt identification and treatment of postoperative complications. Aim: To analyze the impact of a structured discharge plan on the incidence of postoperative complications and the readmission rate in a cohort of 141 patients.

Methods

In 2014 a structured discharge plan that included a detailed description of diet, physical activity, medications and warning signs was implemented. This plan also included a structured phone call the day after surgery looking for abnormal symptoms, signs and recovery. The information was captured in a database. A descriptive analysis was performed, focusing specifically in the incidence, type and outcome of complications as well as the readmission rate and its causes.

Results

In the 3 year study period, 141 patients underwent primary bariatric surgery at our center. A total of 109 patients underwent a laparoscopic Roux-en-Y Gastric Bypass (RYGB) and 32 a Sleeve Gastrectomy (SG). There were 51 males and 90 females with a mean age of 41±13.5years. Mean hospital stay was 2±0.6 days. Three patients developed immediate postoperative complications, 2 presented mild gastrointestinal bleeding that resolved spontaneously and 1 obstruction of the SG that required surgical reintervention. The most frequent symptoms reported in the follow-up phone call were abdominal pain (41 patients) nausea (27 patients), headache (7 patients), and pain in left shoulder (5 patients). All symptoms resolved spontaneously. Postoperative complications after discharge requiring hospital readmission occurred in 3 patients (2.12%). One patient developed portal vein thrombosis, 1 patient presented with intestinal occlusion and 1 with a gastric leak. Both patients underwent surgical reintervention. Mean duration of the hospital readmission was 14±10 days. There was no surgical mortality and all complications resolved uneventfully.

Conclusions

Our structured discharge plan along with the phone call one day after surgery, led to a low readmission rate. However, hospital readmission was still required in 3 patients.