Next Up: Fast Track Bariatric Surgery

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is frequently the go-to procedure for patients with complex or morbid obesity who need or want to reduce their weights. Laparoscopic procedures are attractive to surgeons, insurers and patients because in addition to being as effective as other procedures, they shorten hospital stay and allow patients to heal more quickly compared to other bariatric surgeries. Hospital stays of a few days are common, however, and all stakeholders would like to see a “fast-track” procedure that would allow next-day discharge.

Researchers from the University of Leeds in the UK describe such a procedure in the September 2014 issue of Obesity Surgery.

This was a single-surgeon study covering all patients operated on during the study period. The researchers describe a 3-component system:

• All patients were considered eligible; preoperative factors did not predict longer hospital stays or complications
• All patients were counseled about fast-track discharge.
• Only complete blood count and serum C-reactive protein (CRP) are routinely drawn postoperatively

The researchers examined 112 patients with median BMI 49.4 who underwent a LRYGB during a 3-year period. Ninety-eight patients (87.5 %) were discharged the day after LRYGB.

Among patients who were fast-tracked, only 5 developed complications (three major, two minor). All of these patients had CRPs greater than 100 mg/L on postoperative day 1; the researchers consider this one factor predictive of major complications with 100 % sensitivity and 95 % specificity.

The researchers note that managing patient expectations—a topic rarely discussed in detail in the literature—is critical to success. They provided pre-surgical counseling, and repeated the counseling on the day of and the day after the procedure. They conclude, “The vast majority of patients to be safely and successfully discharged on postoperative day 1.”