Lisa A Bevilacqua1, Nabeel R Obeid, MD2, Konstantinos Spaniolas, MD1, Andrew T Bates, MD1, Salvatore Docimo Jr., MD1, Donna M Zimmermann, BS1, Aurora D Pryor, MD, FACS1. 1Stony Brook University School of Medicine, 2University of Michigan
Introduction: Pathways for enhanced recovery after surgery (ERAS) have been shown to improve length of stay and postoperative complication rates across various surgical fields, however there is a relative lack of evidence-based studies in bariatric surgery. The objective of the current study was to determine if starting a bariatric full liquid diet on postoperative day (POD) zero was associated with shorter length of stay (LOS) for patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-y gastric bypass (RYGB).
Methods: Retrospective review of a prospectively collected dataset was conducted at a single institution before and after implementation of a new diet protocol for LSG and RYGB. Postoperative diet orders were changed from full liquid diet on POD 1 to POD 0. Length of stay and 30-day readmissions were reviewed from June 2016 to August 2017. Independent samples t-tests were used to compare continuous variables and chi-squared tests for categorical variables before and after diet change was implemented. Patients were excluded if they were undergoing revision surgery, were discharged directly from PACU, or had significant intraoperative complications or required reoperation within the same admission.
Results: A total of 86 patients were eligible for inclusion; 54.7% of cases occurred prior to ERAS diet implementation. The mean age was 44.2 (SD=15.4) and mean preoperative BMI was 47.5 (SD=8.0). The majority of patients were female (74.4%) and underwent LSG (67.4%). The mean LOS for the entire sample was 38.5 hours (SD=18.0). This was significantly shorter for LSG vs. RYGB (36.3 vs. 39.5 hours; p= 0.024). LOS across both procedures was shorter after ERAS diet protocol was implemented (39.0 vs. 35.3 hours; p=0.48). This difference was significant for LSG (39.0 vs. 31.3 hours, p=0.008) but not for RYGB patients (39.2 vs. 39.7 hours, p=0.93). There were a total of 4 readmissions within 30 days of surgery with no difference pre- and post-ERAS diet implementation (p=0.402).
Conclusions: Early postoperative feeding the same day of bariatric surgery is associated with significantly shorter LOS for patients who undergo LSG but not RYGB, with no difference in 30-day readmissions. Future prospective studies are needed to support these findings and evaluate the impact of early feeding in combination with other components of ERAS pathways on bariatric surgical outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86196
Program Number: P354
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster