{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:59:29Z","timestamp":1791547169894,"version":"4.3.4"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009913","name":"Naval Medical Center San Diego","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009913","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Enhanced recovery after surgery (ERAS) pathways have reduced hospital stays after bariatric surgery, yet a subset of patients still require prolonged hospitalization. We aimed to identify predictors of delayed discharge and develop a validated clinical nomogram to estimate the likelihood of\u2009&gt;\u20091\u00a0day postoperative stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study of consecutive adults undergoing primary or revisional minimally invasive sleeve gastrectomy or Roux-en-Y gastric bypass at a single military treatment facility from 01\/01\/2022 to 12\/31\/2024. Demographic, comorbidity, operative, and perioperative data were abstracted. The 2023 cohort served as the development set for univariable and multivariable logistic regression to identify predictors of delayed discharge (&gt;\u20091\u00a0day). A clinical nomogram was constructed from independent predictors and internally validated via bootstrap resampling (200 iterations). Temporal validation was performed on 2022 and 2024 cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 281 patients (mean age 47.2\u2009\u00b1\u200911.3\u00a0years; mean BMI 40.5\u2009\u00b1\u20096.0\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; 26.7% male), 141 (50.2%) experienced delayed discharge. Independent predictors included operative time\u2009&gt;\u2009150\u00a0min (OR 3.00, 95% CI 1.14\u20138.09), overnight hydromorphone use (OR 3.78, 95% CI 1.40\u201311.0),\u2009\u2265\u20091 overnight antiemetic dose (OR 2.55, 95% CI 1.04\u20136.27), postoperative day (POD) 0 oral intake\u2009&lt;\u2009200\u00a0mL (OR 2.43, 95% CI 1.01\u20136.01), and POD 1 hemoglobin decrease\u2009\u2265\u20092\u00a0g\/dL (OR 4.16, 95% CI 1.25\u201315.3). The final five-variable model demonstrated strong discrimination (AUC 0.77; bias-corrected C-index 0.74) and calibration (Hosmer\u2013Lemeshow\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.17). Temporal validation confirmed robust performance (AUC 0.77\u20130.87). In sensitivity analysis, model discrimination remained high for both primary (AUC 0.79) and revisional cases (AUC 0.88). A web-based Shiny risk calculator was developed for bedside use\u00a0(\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/michaeltolson.shinyapps.io\/bariatric-delayed-discharge-2023\/\" ext-link-type=\"uri\">https:\/\/michaeltolson.shinyapps.io\/bariatric-delayed-discharge-2023\/<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A five-variable nomogram accurately predicts delayed discharge following bariatric surgery and demonstrated strong temporal validation. This tool may aid individualized discharge planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12663-2","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T18:09:05Z","timestamp":1772820545000},"page":"4158-4168","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and temporal validation of a clinical nomogram to predict delayed discharge after bariatric surgery"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8865-0267","authenticated-orcid":false,"given":"Michael T.","family":"Olson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun Beom","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Masella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D.","family":"Layton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"issue":"1","key":"12663_CR1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-57724-5","volume":"14","author":"LZ Pipek","year":"2024","unstructured":"Pipek LZ, Moraes WAF, Nobetani RM et al (2024) Surgery is associated with better long-term outcomes than pharmacological treatment for obesity: a systematic review and meta-analysis. Sci Rep 14(1):9521. https:\/\/doi.org\/10.1038\/s41598-024-57724-5","journal-title":"Sci Rep"},{"issue":"4","key":"12663_CR2","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1007\/s00268-021-06394-9","volume":"46","author":"E Stenberg","year":"2022","unstructured":"Stenberg E, Dos Reis Falc\u00e3o LF, O\u2019Kane M et al (2022) Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: a 2021 update. World J Surg 46(4):729\u2013751. https:\/\/doi.org\/10.1007\/s00268-021-06394-9","journal-title":"World J Surg"},{"key":"12663_CR3","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000001633","author":"S Suh","year":"2025","unstructured":"Suh S, Yang K, Chunara F et al (2025) Safety of same-day discharge after sleeve gastrectomy in adults 65 years and older. J Am Coll Surg. https:\/\/doi.org\/10.1097\/XCS.0000000000001633","journal-title":"J Am Coll Surg."},{"issue":"12","key":"12663_CR4","doi-asserted-by":"publisher","first-page":"7563","DOI":"10.1007\/s00464-024-11189-9","volume":"38","author":"W Alam","year":"2024","unstructured":"Alam W, Wisely J, Nasser H (2024) Perioperative outcomes of same-day discharge laparoscopic Roux-en-Y gastric bypass using the MBSAQIP database. Surg Endosc 38(12):7563\u20137568. https:\/\/doi.org\/10.1007\/s00464-024-11189-9","journal-title":"Surg Endosc"},{"issue":"1","key":"12663_CR5","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-025-04036-1","volume":"25","author":"H Aref","year":"2025","unstructured":"Aref H, Yunus T, Farghaly M et al (2025) Comparative outcomes of ERAS and conventional methods in laparoscopic sleeve gastrectomy: a 5-year prospective cohort study in Saudi Arabia. BMC Gastroenterol 25(1):615. https:\/\/doi.org\/10.1186\/s12876-025-04036-1","journal-title":"BMC Gastroenterol"},{"issue":"2","key":"12663_CR6","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.surg.2015.03.051","volume":"158","author":"AW Lois","year":"2015","unstructured":"Lois AW, Frelich MJ, Sahr NA, Hohmann SF, Wang T, Gould JC (2015) The relationship between length of stay and readmissions in bariatric surgery patients. Surgery 158(2):501\u2013507. https:\/\/doi.org\/10.1016\/j.surg.2015.03.051","journal-title":"Surgery"},{"issue":"3","key":"12663_CR7","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1007\/s00464-011-1947-z","volume":"26","author":"RM Dallal","year":"2012","unstructured":"Dallal RM, Trang A (2012) Analysis of perioperative outcomes, length of hospital stay, and readmission rate after gastric bypass. Surg Endosc 26(3):754\u2013758. https:\/\/doi.org\/10.1007\/s00464-011-1947-z","journal-title":"Surg Endosc"},{"issue":"2","key":"12663_CR8","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1007\/s11605-017-3642-4","volume":"22","author":"R Fletcher","year":"2018","unstructured":"Fletcher R, Deal R, Kubasiak J, Torquati A, Omotosho P (2018) Predictors of increased length of hospital stay following laparoscopic sleeve gastrectomy from the National Surgical Quality Improvement Program. J Gastrointest Surg 22(2):274\u2013278. https:\/\/doi.org\/10.1007\/s11605-017-3642-4","journal-title":"J Gastrointest Surg"},{"issue":"6","key":"12663_CR9","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1007\/s11695-019-03757-z","volume":"29","author":"M Meneveau","year":"2019","unstructured":"Meneveau M, Mehaffey JH, Adams PD, Turrentine FE, Schirmer B, Hallowell PT (2019) Modifiable factors to prevent prolonged length of stay after sleeve gastrectomy. Obes Surg 29(6):1751\u20131755. https:\/\/doi.org\/10.1007\/s11695-019-03757-z","journal-title":"Obes Surg"},{"issue":"2","key":"12663_CR10","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1007\/s11695-017-2844-x","volume":"28","author":"P Major","year":"2018","unstructured":"Major P, Wysocki M, Torbicz G et al (2018) Risk factors for prolonged length of hospital stay and readmissions after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Obes Surg 28(2):323\u2013332. https:\/\/doi.org\/10.1007\/s11695-017-2844-x","journal-title":"Obes Surg"},{"issue":"6","key":"12663_CR11","doi-asserted-by":"publisher","first-page":"2395","DOI":"10.1007\/s11695-020-04507-2","volume":"30","author":"LMG Nijland","year":"2020","unstructured":"Nijland LMG, de Castro SMM, van Veen RN (2020) Risk factors associated with prolonged hospital stay and readmission in patients after primary bariatric surgery. Obes Surg 30(6):2395\u20132402. https:\/\/doi.org\/10.1007\/s11695-020-04507-2","journal-title":"Obes Surg"},{"issue":"4","key":"12663_CR12","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344\u2013349. https:\/\/doi.org\/10.1016\/j.jclinepi.2007.11.008","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"12663_CR13","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1016\/j.soard.2014.05.016","volume":"11","author":"J Carter","year":"2015","unstructured":"Carter J, Elliott S, Kaplan J, Lin M, Posselt A, Rogers S (2015) Predictors of hospital stay following laparoscopic gastric bypass: analysis of 9,593 patients from the National Surgical Quality Improvement Program. Surg Obes Relat Dis 11(2):288\u2013294. https:\/\/doi.org\/10.1016\/j.soard.2014.05.016","journal-title":"Surg Obes Relat Dis"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-12663-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-026-12663-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-12663-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T22:43:26Z","timestamp":1782859406000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-026-12663-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,6]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["12663"],"URL":"https:\/\/doi.org\/10.1007\/s00464-026-12663-2","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,6]]},"assertion":[{"value":"8 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Disclosures\u00a0\n                      The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, the Department of Defense, or any agency of the United States Government. Olson MT, Lee YB, Masella P, and Layton B have no conflicts of interest or financial ties to disclose.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations\u00a0\u00a0"}}]}}