Objectives

E valuate the safety of FTS program in patients undergoing primary and revision bariatric surgery; identify  the factors  that may limit early discharge in both groups.

Methods:

Retrospective review of 547 consecutive morbid obese patients who underwent bariatric procedures between January 2016 - July 2017. Fast track protocol is applied on all patients. Target discharge after one-night stay. The primary end point length of stay in the hospital.  The secondary end points frequency of hospital contact, readmission and reintervention within 30 days after the surgery.

Results:

Primary (n=475); banded bypass (BRYGB, 78.1%), sleeve gastrectomy (10.9%), gastric band (5.1%), non-banded RYGB (3.8%), one-anastomosis gastric bypass (1.9%), BPD (0.2%). Mean age (±SD) 44.7 ± 11.2 years and BMI mean (±SD) 43.7 ± 6.1 kg/m2. Revision procedures (n=72); gastric band to adjustable BRYGB (41.7%) and to non-adjustable BRYGB (40.3%), Mason to BRYGB (11.1%), one-anastmosis bypass to BRYGB (1.4%), Sleeve to BRYGB (2.8%), sleeve to SADI (1.4%), band to sleeve (1.4%). Mean age (±SD) 47.5± 9.1 years and BMI mean (±SD) 38.4 ± 6.95 kg/m2.

Total 30-day readmissions in primary and revision were 32 (6.7%) and 5 (6.9%). Total re-interventions 14 primary (2.9%) and 2 revisions (2.8 %). One case of mortality due to neglected port site hernia.  

Mean LOS in primary patients was 1.32± 0.98 and 1.56 ± 1.6 for revision. Successful discharge at same day 7 (5 primary and 2 revision), one night 474 (420 primary and 54 revision). After one-night discharge, Incidence of contact to the hospital, readmission and reintervention were 25.7%, 6.9%, 1.9%, in the primary group and 27.8%, 5.6%, 0% in revision respectively. There were no statistically significant differences in the incidence of  contact to hospital, readmission and reintervention between primary and revision patients discharged after one-night

Extended LOS after primary procedures was significantly affected by gender, diabetes and associated non-bariatric intervention.

Conclusion

The FTS is safe in both primary and revision surgery with no statistically significance difference in the clinical outcomes.