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

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Abstract

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.

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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.

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Authors and Affiliations

  1. Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, The Medical School of Temple University/St Luke’s University Hospital and Health Network, 1736 Hamilton Boulevard, Allentown, PA, 18104, USA

    Maher El Chaar, Leonardo Claros, George C Ezeji & Maureen Miletics

  2. Research Institute, St Luke’s University Hospital and Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA

    Jill Stoltzfus

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  1. Maher El Chaar
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  2. Leonardo Claros
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  3. George C Ezeji
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  4. Maureen Miletics
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  5. Jill Stoltzfus
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Correspondence to Maher El Chaar.

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El Chaar, M., Claros, L., Ezeji, G.C. et al. Improving Outcome of Bariatric Surgery: Best Practices in an Accredited Surgical Center. OBES SURG 24, 1057–1063 (2014). https://doi.org/10.1007/s11695-014-1209-y

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  • DOI: https://doi.org/10.1007/s11695-014-1209-y

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