DECREASED HOSPITAL LENGTH OF STAY WITH MAGNETIC LIVER RETRACTION AFTER BARIATRIC SURGERY
Leonard K. Welsh*, Gerardo Davalos, Ramon Diaz, Rafael Luengas, Dana Portenier, Daniel Guerron
Department of Surgery, Duke University, Durham, NC
Background: Retraction of the liver is essential for visualization of the gastroesophageal junction in bariatric surgery. Various devices are used such as externally mounted retractors that require an additional port or incision. Magnetic retractors provide effective transabdominal liver retraction without the need of a dedicated port or incision and are safe and effective in laparoscopic surgery. Fewer incisions may impact postoperative pain and decrease hospital length of stay.
Methods: Medical records of patients who underwent laparoscopic bariatric surgery with the use of a transabdominal magnetic liver retractor (MLR) from October 2016 to July 2018 at a single institution were reviewed. Patients were grouped by operation-Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or duodenal switch (DS) and compared to control groups of consecutive cases completed during the same time period where an externally-mounted Nathanson retractor was used. Basic demographic data and comorbidities were obtained. Outcomes of operative time, operating room supply costs, hospital length of stay (LOS), and total hospital charges were included in the analysis. Variables were compared with an independent samples t test. Values are expressed as means with standard deviations or number with percent of total as applicable.
Results: 104 MLR patient records were acquired. Three patients were excluded due to incomplete records resulting in 43 RYGB, 33 SG, and 25 DS. The control cohort generated 615 total patient records. Nine were excluded due to incomplete data and three (1 RYGB, 2 DS) were excluded due to exceptionally prolonged LOS (beyond 4 standard deviations from the mean) to avoid skewing. The final control groups consisted of 358 RYGB, 201 SG, and 44 DS patients. Demographic characteristics and comorbidities were comparable between cohorts (Table 1). Outcome results are reported in Table 2. Operative costs were higher in MLR for RYGB and DS, $4,279 vs $3,993 (P=0.01) and $5,850 vs $5,379 (P=0.05), while LOS was significantly lower, 1.16 vs 1.48 days (P=<0.001) and 2.68 vs 3.34 days (P= 0.02) respectively. The only observed difference in SG was a shorter operative time in the MLR cohort, 116 vs 128 minutes (P=0.004). There was no difference in total hospital charges in all groups.
Conclusion: While the use magnetic liver retractors in bariatric surgery increases operating costs, it results in decreased LOS in RYGB and DS patients. Shorter LOS may increase patient satisfaction and decrease overall resource utilization burdens. Decreased pain from fewer incisions stands as a possible explanation for a lower LOS with magnetic retraction; however, this relationship requires further investigation.
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