Five Years, Two Surgeons, and over 500 Bariatric Procedures: What Have We Learned?

• Published in: Obesity surgery Vol. 27; no. 10; pp. 2742 - 2749
• Main Authors: Shea, Brian, Boyan, William, Botta, James, Ali, Syed, Fenig, Yaniv, Paulin, Ethan, Binenbaum, Steven, Borao, Frank
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2017; Springer Nature B.V
• Subjects: Adult; Bariatric Surgery - adverse effects; Bariatric Surgery - education; Bariatric Surgery - methods; Bariatric Surgery - standards; Comorbidity; Female; Gastrointestinal surgery; Hospital costs; How I Do It; Humans; Laparoscopy - adverse effects; Laparoscopy - education; Laparoscopy - methods; Laparoscopy - statistics & numerical data; Learning; Length of Stay - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Obesity; Obesity, Morbid - epidemiology; Obesity, Morbid - surgery; Postoperative Care - methods; Postoperative Care - statistics & numerical data; Postoperative Period; Reoperation - education; Reoperation - methods; Reoperation - statistics & numerical data; Retrospective Studies; Surgeons; Surgeons - education; Surgeons - statistics & numerical data; Surgery; Time Factors; Weight control; Weight Loss; Fast track; Obesity surgery; Laparoscopic Roux-en-Y gastric bypass; Advanced recovery; Weight loss surgery; Laparoscopic sleeve gastrectomy; ERAS
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-017-2873-5

Background Bariatric surgery has become an increasingly popular method for weight loss and mitigation of co-morbidities in the obese population. Like any field, there is a desire to standardize and accelerate the postoperative period while maintaining safe outcomes. Methods All laparoscopic sleeve gastrectomies (LSG) and gastric bypasses (LGB) were performed over a 5-year period were logged along with several aspects of postoperative care. Trends were followed in aspects of postoperative care over years as well as any documentation of complications or re-admissions. Results A total of 545 LSGs and LBPs were performed between 2012 and 2016. Improvements were noted in nearly every field over time, including faster Foley removal, decreased length of hospital stay, decreased use of patient controlled analgesics (PCAs), and faster advancement of diet. There was also an abandonment of utilization of the ICU and step down setting for these patients, leading to significant decreases in hospital cost. There was no change in complications, re-operations, or re-admission in this time period. Conclusions The surgeons involved in this project have built a busy bariatric surgery practice, while continually evolving the postoperative algorithm. Nearly every aspect of postoperative care has been deescalated while decreasing length of stay and cost to the hospital. All of this has been obtained without incurring any increase in complications, re-operations, or re-admissions. The authors of this paper hope to use this article as a launching point for a formal advanced recovery pathway for bariatric surgery at their institution and others.