Decreased Leak Rate and Need for Reintervention with Use of Closed Suction Calibration System: a Bariatric Surgery Quality Improvement Project.

BACKGROUND Laparoscopic sleeve gastrectomy (SG) continues to grow in popularity as a primary bariatric procedure. The purpose of this study is to determine if leak rates and need for subsequent interventions are changed by the standardized use of a closed suction calibration system (CSCS) at a high-volume urban hospital. METHODS A retrospective review was conducted between January 1, 2016, and December 31, 2018, on SG patients. All cases performed in 2018 were completed with a closed suction calibration system. Patient demographics, comorbidities, operative variables, and outcomes were collected. Descriptive statistics and chi-squared test were used to compare the two groups. Logistic regression models were adjusted for patient- and procedure-specific factors. RESULTS Four hundred ninety cases were performed before and 195 after institution of the CSCS. Groups were similar in most characteristics, including median body mass index (BMI) (46.4 vs 45.8 kg/m2, p = 0.79). Those in the closed suction cohort were more likely to have OSA requiring therapy (32.4% vs 46.6%, p < 0.01) and to have their cases performed robotically (55.4% vs 39.6%, p = 0.02). Post introduction of the CSCS, the overall leak rate was 0% (1.4% vs 0%, p = 0.09); overall need for postoperative interventions decreased (9.6% vs 2.6%, p = 0.009). After adjustment, a 69% decrease was observed in need for related additional intervention [aOR 0.31 (0.12-0.81), p = 0.017]. CONCLUSION The use of a standardized closed suction calibration system resulted in overall decreased leak rates, which was associated with a clinically significant decrease in additional interventions.