Methods
A retrospective study utilising data from the National Bariatric Surgery Register was performed. Ethical approval for the study was obtained via the local review board. Inclusion criteria was all patients who underwent either only a laparoscopic sleeve gastrectomy or a Roux-en-Y bypass between July 2015 and February 2018. All surgeries were performed by a single senior bariatric surgeon (SR) at a single site (King’s College Hospital, London) to reduce bias. Any patients who had immediate complications intra- or peri-operatively were excluded from the study such as bleeding or those requiring additional intra-operative procedures. Six such patients were excluded. A total of 230 patients (112 Sleeve Gastectomies and 118 Gastric Bypasses) were identified for the study.
All patients were managed according to the department surgical protocol. The principles of this protocol are:
  1. Pre-operative counselling and patient education
  2. Antithrombotic prophylaxis (Dalteparin 5,000 units, OD <100kg, BD >100kg)
  3. Laparoscopic surgery
  4. Balanced intravenous fluid therapy
  5. Early mobilisation
Post-operative length of stay was defined as the number of 24 hour periods from completion of the operation to the day of discharge. Discharge criteria was:
  1. Patient tolerating free fluids
  2. Healing surgical wounds with no evidence of infection/dehiscence
  3. Afebrile
  4. Pain controlled with oral analgesia
  5. No requirement for intravenous support
  6. Balanced diuresis
  7. Mobility allowing for completion of required daily activities
Data was collected using Microsoft Excel (Microsoft ® Excel for Mac, Version 15.28. Redmond, Washington, United States). All data was collected by healthcare professionals and was anonymised. The significance of: BMI, ASA grade, a diagnosis of diabetes and the day of the week the operation occurred, on post-operative stay was evaluated using Kruskal Wallis analysis. Post hoc analysis was done with Mann-Whitney testing. Statistics was performed using SPSS (’IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, New Yord: IBM Corp.) The threshold for statistical significance was 0.05.