Trends in Drain Utilization in Bariatric Surgery: an Analysis of the MBSAQIP Database 2015-2017.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (SG) are the two most common bariatric operations. With the implementation of enhanced recovery protocols, the use of drains should decrease. METHODS: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was queried for the years 2015-2017. Our inclusion criteria included all patients undergoing a primary LRYGB, SG, and revisions. We examined demographics, operative characteristics, the use of drains, and postoperative complications. Continuous variables were summarized using means and standard deviations (SD). Categorical variables were summarized using frequencies and proportions. Student's T test (Wilcoxon sum rank test in the case of skewed data) and chi-squared analysis were used to assess the baseline differences in drain utilization. RESULTS: From 2015 to 2017, there were 388,239 bariatric cases performed without drains and 100,221 performed with drains. Twenty-nine percent of LRYGB patients had a drain placed but only 16.7% of SG patients. The percentage of LRYGB that had a drain dropped from 33.1 to 24.6% during the study period and that of SG dropped from 20.3 to 13.6%. Patients that had drains placed were more likely to have a provocative test at the time of surgery (prevalence ratio (PR) 2.24) and to have a postoperative swallow study (PR 1.93). CONCLUSIONS: Drains are still commonly used in bariatric patients. Over the study period, there was a decrease in the use of drains in both bypass and sleeve patients. Patients with a drain were more likely to have had a provocative test and a swallow study and have a higher rate of complications and mortality.

Utilization of Laparoscopic Colon Surgery in the Texas Inpatient Public Use Data File (PUDF).

BACKGROUND: Laparoscopic surgery has become the standard of care for the most common surgical procedures performed. However, laparoscopic techniques have not reached this same penetrance in colorectal surgery. We wanted to determine the percentage of colon operations performed in Texas that were done via laparoscopic, robotic and open techniques. METHODS: The Texas Inpatient Public Use Data File (PUDF) was queried using ICD-9-CM diagnostic and procedure codes to determine overall utilization of laparoscopic colectomies (LC) in Texas between 2013-14 for reporting facilities. We specifically looked at cost and the length of stay for LC, open colectomy (OC) and robotic assisted colectomy (RAC). RESULTS: In the state of Texas between 2013-14 there were 20,454 colectomies performed. Of these 12,328 (60.3%) were OC, 7,536 (36.8%) were LC, and 590 (3.9%) were RAC. Average total cost was $117,113 for OC, $75,741.9 for LC, and $81,996.2 for RAC. Average length of stay for each technique was 10.6 days for OC, 6.1 days for LC, and 5.1 days for RAC. The risk of a postoperative complication occurring was higher in the open procedure than a laparoscopic procedure. CONCLUSIONS: LC accounted for only 36.8% of all colectomies performed in Texas between 2013-14. OC costs twice as much as LC and increased the length of stay by nearly 4 d. LC and RAC are both associated with significantly less cost and length of stay for patients undergoing surgery, while lowering perioperative complications. DISCLOSURES: None of the authors have any relevant disclosures.