Implementation of an Enhanced Recovery Program for Bariatric Surgery

James P Taylor, MBBChir, MPH, Daniel Prior, MD, Miloslawa Stem, MS, Alisa M Coker, MD, Hien Nguyen, MD, Thomas Magnuson, MD, Gina L Adrales, MD, MPH, Michael Schweitzer, MD. Johns Hopkins

INTRODUCTION: Enhanced recovery programs have been successfully implemented in several surgical fields over the past two decades; however there have been mixed results observed in bariatric surgery. Our institution implemented an enhanced recovery program with specific pre-, intra- and post-operative goals aimed at patients, nursing staff and physicians. The aim of the study is to observe the effectiveness of the program, with primary outcomes the length of stay, 30-day readmissions and total cost.

METHODS: Adult patients who underwent Bariatric surgery prior to the implementation of the enhanced recovery program in the calendar year 2015 were compared to those who had surgery after implementation in 2017. Data was drawn from the Premier Perspective® Hospital Database and analyzed utilizing IBM SPSS®.

RESULTS: 277 bariatric surgical procedures were performed in 2015, compared to 348 procedures in 2017. While there was a 25.6% increase in case volume, there was no statistical difference between the patient populations or the type of procedure performed between the two years. A decrease in length of stay was observed from 2.77 days in 2015 to 1.78 days in 2017 (p<0.001) (Figure 1A), while cost was also cut ($12,618.54 in 2015 vs. $10,097.09 in 2017 (p<0.001)) (Figure 1B). 30-day readmission rate also decreased from 7.9% in 2015 to 2.9% in 2017 (p=0.004).

CONCLUSION: The implementation of the enhanced recovery program resulted in reduced length of stay, 30-day readmissions, and cost. Total costs saved by the institution were greater than $800,000 in one calendar year. This study highlights that the value of an enhanced recovery program can be observed in bariatric surgery, with both patients and hospital systems benefitting.