We reviewed 1 surgeon's experience after implementation of a 1-day fast-track protocol (FTP) in 784 primary and 36 revisional consecutive LRYGB patients. Patient demographics, comorbidities, preoperative laboratory values, diagnostic work-up, operative characteristics, LOS, 30-day outcomes, and patient satisfaction scores were prospectively collected in a deidentified registry. Predictors of longer hospitalization were assessed by univariate and multiple regression analysis.
One-day LOS was accomplished in 71.9% primary and 58.3% revisional LRYGBs. Median LOS was 1 day for primary and revisional LRYGB and mean lengths of stay were 1.34 and 1.63 days, respectively. “Excellent” or “very good” satisfaction ratings were reported regarding the FTP education provided (95.3%), surgeon's accessibility (98.3%), and hospital care (86.5%). Only 0.34% of patients who had a 1-day LOS indicated that they would benefit from an additional in-hospital stay. In multivariate analysis, independent predictors of longer hospitalization included prolonged operative time, hemoglobin reduction, reoperation for primary LRYGB, and operative time for revisional LRYGB.
A 1-day FTP can be successfully implemented in the majority of primary and revisional LRYGB patients regardless of preoperative patient characteristics without increasing the risk of 30-day morbidity, mortality, reoperations, readmissions, emergency department or outpatient fluid visits, or reducing patient satisfaction.