Background and Goal of Study: There are pressures to shorten hospital stay within the UK health service. Our regional bariatric surgical service has implemented a number of progressive changes to enhance recovery in a population of morbidly obese patients undergoing gastric bypass surgery.
Materials and Methods: Analysis was performed on prospectively collected data of all bariatric patients treated between Jan 2007 and Nov 2010 at our regional centre. Patient demographics, length of stay and procedural data were collected from anaesthetic charts, theatre records and the Hospital Information System, then collated on an anaesthetic database. Analysis of variance with Kruskal-Wallis test was performed to compare yearly data.
Results and Discussion: A total of 1,007 patients under went Gastric Bypass (RYGB) during the four-year period. Median BMI, procedure, ASA status and length of stay are presented in the table.
Lengths of stay are significantly reduced every year over this period. In part this is due to increased utilisation of laparoscopic surgery, no routine nasogastric tubes or wound drainage, shorter acting anaesthetic agents and the use of more co-analgesics to reduce morphine consumption. There has however also been a change in the population undergoing bypass surgery, who are slightly smaller and fitter but overall there was 70 patients with a BMI of >70 kg/m2.
Conclusion(s): Although there are confounding factors, in a population of very large NHS patients with significant co-morbidities, the implementation of enhanced recovery techniques has resulted in dramatic reductions in length of stay.