Eric Duffy, DO, Vickie Kassapidis, Vadim Meytes, DO, George Ferzli, MD. NYU Langone Hospital – Brooklyn
Background: Morbid obesity, a common medical concern with significant health risks, has a prevalence of 10.4% among U.S. adults. Bariatric surgery provides effective weight loss for morbidly obese patients with improvement in their comorbid conditions. Traditionally, routine intraoperative drain placement (IDP) and postoperative esophagram (UGIS) were thought to identify early postoperative complications. Recently, these interventions have been scrutinized for their effectiveness. We hypothesized that IDP and postoperative UGIS do not alter outcomes in bariatric surgery and only increase hospital length of stay (LOS).
Methods: Two cohorts, each consisting of 100 patients from either 2015 or 2017 were analyzed from our institution. In the 2015 cohort, all patients had IDP and an UGIS on postoperative day 1, prior to starting a clear liquid diet. In the 2017 cohort, no patients had IDP or UGIS, but instead were started on a clear liquid diet on postoperative day 1, in the absence of vomiting. All patients in each cohort underwent either a laparoscopic sleeve gastrectomy or a Roux-en-Y gastric bypass. A retrospective study was performed to analyze whether there was a significant difference in postoperative complications, length of stay, and operating room time between these two cohorts.
Results: The average bariatric procedure duration was 85.04 minutes in 2015 as compared to 124.68 minutes in 2017, with a p-value of < 0.001. This discrepancy can be attributed to the greater number of surgeons operating in 2017, 8 in 2017 compared to 3 in 2015. The length of stay in 2015 averaged 2.42 days, compared to 1.44 days in 2017, with a p-value of < 0.001. For patients with complications, all were Clavien-Dindo Grade 1-2 and did not require any invasive interventions. The complication rate was 0.07 in 2015 and 0.02 in 2017 with a p-value of 0.089 with all complications being early minor ones. The readmission rate within 30 days was the same in both groups, 0.03.
Conclusion: Our retrospective study results support the initial hypothesis that IDP and postoperative UGIS do not alter outcomes in bariatric surgery. Moreover, we found that stopping routine use of IDP and UGIS significantly reduced LOS while complication rates remained low. Therefore, we do not recommend routine use of IDP and UGIS in the uncomplicated bariatric patient.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86238
Program Number: P585
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster