Obesity Surgery

, Volume 24, Issue 7, pp 1057–1063 | Cite as

Improving Outcome of Bariatric Surgery: Best Practices in an Accredited Surgical Center

  • Maher El Chaar
  • Leonardo Claros
  • George C Ezeji
  • Maureen Miletics
  • Jill Stoltzfus
Original Contributions


The number of laparoscopic bariatric procedures being performed in the USA has increased dramatically in the past decade. Because of limited health-care resources, hospital administrators and insurance carriers are placing emphasis on length of stay and patient outcomes. The goal of this study was to evaluate the feasibility and safety of a clinical pathway in managing patients undergoing bariatric surgery in a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accredited center. The setting was a university hospital in USA. A retrospective analysis of data collected prospectively on patients undergoing bariatric surgery at St Luke’s University was performed. Patients included underwent either a laparoscopic Roux-en-Y gastric Bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG). Patients were subjected to a clinical protocol and discharged when discharge criteria were met. The primary outcomes were length of stay, 30 day readmission, complication, and reoperation rates. A cost analysis of the savings accrued was also performed. Two hundred twenty-nine patients were included in our analysis (80.4 % females and 19.6 % males). Seventy-one patients (31 %) underwent LSG, and 158 patients (69 %) underwent LRYGB. The average length of stay was 32.45 h (range 24–72 h). The 30-day readmission rate was 3.0 % (7/229 patients). The 30 day complication rate (including intervention, reintubation, and reoperation) was 2.6 % (6/229). The 30 day mortality rate was 0. The average prospective cost savings were $2,016 and $1,209 per LRYGB and LSG patient, respectively. Our bariatric surgery clinical protocol is feasible and safe with substantial prospective cost savings at St Luke’s University and Health Network. Patients subjected to our protocol have low readmission and complication rates. Further studies are needed to fully elucidate the benefit of this innovative new protocol in bariatric surgery.


Bariatric surgery Laparoscopic sleeve gastrectomy Laparoscopic gastric bypass Obesity surgery Clinical protocol 


Conflict of Interest

Dr. Maher El Chaar, Dr. Ezeji G.C., Dr. Leonardo Claros, Dr. Jill Stoltzfus, and Ms. Maureen Miletics have no conflict of interest to disclose/declare.


  1. 1.
    Nguyen NT, Root J, Zainabadi K, et al. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg. 2005;140(12):1198–202. discussion 1203.PubMedCrossRefGoogle Scholar
  2. 2.
    Feo CV, Lanzara S, Sortini D, et al. Fast track postoperative management after elective colorectal surgery: a controlled trail. Am Surg. 2009;75(12):1247–51.PubMedGoogle Scholar
  3. 3.
    Gouvas N, Tan E, Windsor A, et al. Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Di. 2009;24(10):1119–31.CrossRefGoogle Scholar
  4. 4.
    Counihan TC, Favuzza J. Fast track colorectal surgery. Clin Colon Rectal Surg. 2009;22(1):60–72.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Carli F, Charlebois P, Baldini G, et al. An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery. Can J Anaesth. 2009;56(11):837–42.PubMedCrossRefGoogle Scholar
  6. 6.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89. discussion 289-91.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Baird G, Maxson P, Wrobleski D, Luna BS. Fast-track colorectal surgery program reduces hospital length of stay. Clin Nurse Spec; 24(4):202-8.Google Scholar
  9. 9.
    Ionescu D, Iancu C, Ion D, et al. Implementing fast-track protocol for colorectal surgery: a prospective randomized clinical trial. World J Surg. 2009;33(11):2433–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Holak J. Fast track concept in colorectal surgery in a regional hospital setting. Rozhl Chir. 2009;88(9):524–6.PubMedGoogle Scholar
  11. 11.
    Rix T, Jourdan L. ‘Fast track’ postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery (Br J Surg 2001;88:1533-8). Br J Surg 2002; 89(5):625; author reply 625.Google Scholar
  12. 12.
    Burns EM, Naseem H, Bottle A, et al. Introduction of laparoscopic bariatric surgery in England: observational population cohort study. BMJ; 341:c4296.Google Scholar
  13. 13.
    Kellogg TA, Swan T, Leslie DA, et al. Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(4):416–23.PubMedCrossRefGoogle Scholar
  14. 14.
    Nguyen NT, Slone JA, Nguyen XM, et al. A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity: outcomes, quality of life, and costs. Ann Surg. 2009;250(4):631–41.PubMedGoogle Scholar
  15. 15.
    Tiwari MM, Goede MR, Reynoso JF, et al. Differences in outcomes of laparoscopic gastric bypass. Surg Obes Relat Dis. 2011;7(3):277–82.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Maher El Chaar
    • 1
  • Leonardo Claros
    • 1
  • George C Ezeji
    • 1
  • Maureen Miletics
    • 1
  • Jill Stoltzfus
    • 2
  1. 1.Department of Surgery, Division of Bariatric and Minimally Invasive SurgeryThe Medical School of Temple University/St Luke’s University Hospital and Health NetworkAllentownUSA
  2. 2.Research InstituteSt Luke’s University Hospital and Health NetworkBethlehemUSA

Personalised recommendations