Introduction
Laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-En-Y gastric
bypass (RNY) are first line in the surgical treatment of morbid obesity
in the UK. Their low rates of postoperative morbidity and mortality is
well documented in the literature. In addition, an increased emphasis on
enhanced recovery after surgery (ERAS) has led to a reduction in
hospital length of stay and associated nosocomial
complications.(1)
ERAS protocols are already well established in other surgical
specialities, but have yet to be implemented effectively in bariatric
surgery on a regional or national scale. Meta-analytical studies have
found them to result in a reduced length of stay but no overall
significant effect on mortality or morbidity of bariatric
patients.(2) Despite this increased emphasis on ERAS,
length of stay still represents a significant portion of the cost of
bariatric surgery; with each additional day accumulating approximately
£225 in bed costs. In addition, increased length of stay leads to
additional risks of: venous thromboembolism, hospital acquired
infections, prescription errors, falls/fractures, re-admission and
cancelation of other services due to insufficient hospital
beds(3).
Multiple factors are thought to affect length of hospital stay in these
groups of patients. A diagnosis of diabetes, decreased functional
status, and additional procedures performed alongside the case have all
shown to result in an increased length of stay(4). A
larger BMI is inherently associated with greater risk and studies have
shown a BMI of greater than 50 to significantly delay discharge. It is
important to also consider that a combination of patient-specific
factors and operative factors can influence length of
stay(5).
An increased emphasis on establishing a 7-day NHS is well known, and
this creates a pressure to discharge patients who do not necessarily
need to be in hospital. In fact, studies have shown that early
discharges, particularly on day 1 post op, do not lead to increased
readmission and complications rate in these patients. It stands to
reason that patients should be optimally discharged regardless of which
day of the week it is(6).
Given the finite resources available in the National Health Service, the
aim of this study was to determine the extent that four common factors:
day of the week the operation occurred, BMI, ASA grade and a
pre-operative diagnosis of diabetes, influences the length of
post-operative stay in two common bariatric procedures – SG and RNY.