How Safe is a One-Night Stay Protocol for Patients Undergoing Elective Bariatric Surgery?

ABSTRACT

Background: The availability and popularity of bariatric and metabolic surgery (BMS) continues to increase worldwide and in turn so do the resources allocated to it. The last NBSR report (2020) demonstrated that 70% of patients were discharged on the second postoperative day and 80% left after the third day. An amended protocol was implemented within our Trust switching from a 2-3 night stay and reducing this to a planned one-night stay for a more efficient service. This review evaluates the safety and efficacy of a one-night stay protocol. Method(s) All patients undergoing BMS between two sets of dates were retrospectively identified from our local database, pre and post protocol change. Group A (old protocol, July-December '19) and Group B (one-night stay protocol, July '20-July '21). Group B capture time was extended due to smaller numbers due to COVID. Data gathered included Patient demographics (Age, Gender, ASA, Weight, BMI);operation;length of stay (LOS);30-day complications, 30-day mortality, and 30-day readmission rates. Descriptive statistics and Chi-squared test were used to analyse results. Result(s) Group A had 94 patient and Group B 149 patients. Patient demographics, weight and ASA were similar in both groups. There were significantly more RYGB in Group A whilst more OAGBs and sleeves in Group B RYGB;(48[51%] vs. 30[20%]), OAGB;(32[34%] vs. 80[53%]), Sleeve;(13[14%] vs. 36[24%]). Median LOS reduced from 3 days to 1 day and mean LOS 3.2 days to 1.3 days. In Group B, 115 patients (77%) were discharged on post-operative day 1 vs. 18 (19%) in Group A. In the 34 (23%) of patients that required stay beyond day 1 in Group B the most common reason was post-operative nausea and vomiting (n=8). Other frequent reasons were pain (n=5), low urine output/AKI (n=5) and not tolerating oral diet (n=4). There were no statistically significant differences between groups for 30-day complication (6[6%] vs. 5[3%] p=0.4) or re-admission (4[4%] vs. 8[5%] p=0.9) rates. In sub-group analysis, there was no difference between operation type and LOS/complication rates. In a review of the readmissions, it was not felt any were avoidable and only 1/8 readmissions were within 48h of discharge - this patient already had an extended admission. Conclusion(s) This study demonstrated that a planned one-night stay following BMS is both safe and effective;facilitating early patient discharges whilst having the necessary safety netting steps for those who require a require an extended period in hospital. The next step would be to explore the safety of day case surgery for selected patients undergoing sleeve gastrectomy.