Background

A dramatic reduction in length of stay (LOS) was experienced worldwide after the introduction of laparoscopic bariatric surgery. Numerous protocols have been put in place to expedite patient recovery ever since. We present the evolution of perioperative protocols in an academic bariatric program over the course of 7 years.

Methods

A retrospective analysis of the LOS of primary bariatric patients was studied between 2016 to 2022. Inclusion criteria included primary sleeve gastrectomy (SG) and gastric bypass (GB) patients. Revisional bariatric surgery, lap band and duodenal switch patients were excluded.

Results

A total of 1823 patients were included; 1274 (75%) underwent primary SG and 449 (25%) underwent GB. LOS decreased throughout the study period each year in both combined and cohort analyses. Combined LOS went from 2.5 days in 2016 to 1.5 days in 2022 (R2= 0.97). PCA use, Foley catheters and routine UGI studies were part of standard post-operative care in 2016 resulting in LOS of 2.4 days in SG and 3.1 days in GB patients. Routine tranversus abdominis plane (TAP) blocks, PO pain control, avoidance of Foley catheters and elimination of routine UGI studies became standard practice in 2018 decreasing LOS time to 1.8 and 2.0 days for SG and GB patients, respectively. Most recently in 2020, a discharge checklist and patient fluid tracker were incorporated with reduction LOS to 1.5 days for both SG and GB patients.

Conclusions

LOS can be effectively shortened in a large academic center by implementing pre and post operative standardized protocols.