Introduction
Laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-En-Y gastric bypass (RNY) are first line in the surgical treatment of morbid obesity in the UK. Their low rates of postoperative morbidity and mortality is well documented in the literature. In addition, an increased emphasis on enhanced recovery after surgery (ERAS) has led to a reduction in hospital length of stay and associated nosocomial complications.(1)
ERAS protocols are already well established in other surgical specialities, but have yet to be implemented effectively in bariatric surgery on a regional or national scale. Meta-analytical studies have found them to result in a reduced length of stay but no overall significant effect on mortality or morbidity of bariatric patients.(2) Despite this increased emphasis on ERAS, length of stay still represents a significant portion of the cost of bariatric surgery; with each additional day accumulating approximately £225 in bed costs. In addition, increased length of stay leads to additional risks of: venous thromboembolism, hospital acquired infections, prescription errors, falls/fractures, re-admission and cancelation of other services due to insufficient hospital beds(3).
Multiple factors are thought to affect length of hospital stay in these groups of patients. A diagnosis of diabetes, decreased functional status, and additional procedures performed alongside the case have all shown to result in an increased length of stay(4). A larger BMI is inherently associated with greater risk and studies have shown a BMI of greater than 50 to significantly delay discharge. It is important to also consider that a combination of patient-specific factors and operative factors can influence length of stay(5).
An increased emphasis on establishing a 7-day NHS is well known, and this creates a pressure to discharge patients who do not necessarily need to be in hospital. In fact, studies have shown that early discharges, particularly on day 1 post op, do not lead to increased readmission and complications rate in these patients. It stands to reason that patients should be optimally discharged regardless of which day of the week it is(6).
Given the finite resources available in the National Health Service, the aim of this study was to determine the extent that four common factors: day of the week the operation occurred, BMI, ASA grade and a pre-operative diagnosis of diabetes, influences the length of post-operative stay in two common bariatric procedures – SG and RNY.