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Hart JWH', Takken R, Hogewoning CRC, Biter LU, Apers JA, Zengerink H, Dunkelgrün M, Verhoef C. Markers for Major Complications at Day-One Postoperative in Fast-Track Metabolic Surgery: Updated Metabolic Checklist. Obes Surg 2023; 33:3008-3016. [PMID: 37610699 PMCID: PMC10514089 DOI: 10.1007/s11695-023-06782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION In fast-track metabolic surgery, the window to identify complications is narrow. Postoperative checklists can be useful tools in the decision-making of safe early discharge. The aim of this study was to evaluate the predictive value of a checklist used in metabolic surgery. METHODS Retrospective data from June 2018 to January 2021 was collected on all patients that underwent metabolic surgery in a high-volume bariatric hospital in the Netherlands. Patients without an available checklist were excluded. The primary outcome was major complications and the secondary outcomes were minor complications, readmission, and unplanned hospital visits within 30 days postoperatively. RESULTS Major complications within 30 days postoperatively occurred in 62/1589 (3.9%) of the total included patients. An advise against early discharge was significantly more seen in patients with major complications compared to those without major complications (90.3% versus 48.1%, P < 0.001, respectively), and a negative checklist (advice for discharge) had a negative predictive value of 99.2%. The area under the curve for the total checklist was 0.80 (P < 0.001). Using a cut-off value of ≥3 positive points, the sensitivity and specificity were 65% and 82%, respectively. Individual parameters from the checklist: oral intake, mobilization, calf pain, willingness for discharge, heart rate, drain (>30 ml/24 h), hemoglobin, and leukocytes count were also significantly different between groups. CONCLUSION This checklist is a valuable tool to decide whether patients can be safely discharged early. Heart rate appeared to be the most predictive parameter for the development of major complications. Future studies should conduct prediction models to identify patients at risk for major complications.
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Affiliation(s)
- J W H 't Hart
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands.
| | - R Takken
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - C R C Hogewoning
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - L U Biter
- Department of Surgery, Tulp Medisch Centrum, Zwijndrecht, The Netherlands
| | - J A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - H Zengerink
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - M Dunkelgrün
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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2
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't Hart JWH, Noordman BJ, Wijnand JMA, Biter LU, Verbrugge SJC, Birnie E, Dunkelgrun M, Huisbrink J, Apers JA. Peroperative administration of tranexamic acid in sleeve gastrectomy to reduce hemorrhage: a double-blind randomized controlled trial. Surg Endosc 2023; 37:7455-7463. [PMID: 37400687 PMCID: PMC10520143 DOI: 10.1007/s00464-023-10232-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION In metabolic surgery, hemorrhage is the most common major complication. This study investigated whether peroperative administration of tranexamic acid (TXA) reduced the risk of hemorrhage in patients undergoing laparoscopic sleeve gastrectomy (SG). METHODS In this double-blind randomized controlled trial, patients undergoing primary SG in a high-volume bariatric hospital were randomized (1:1) to receive 1500-mg TXA or placebo peroperatively. Primary outcome measure was peroperative staple line reinforcement using hemostatic clips. Secondary outcome measures were peroperative fibrin sealant use and blood loss, postoperative hemoglobin, heart rate, pain, major and minor complications, length of hospital stay (LOS), side effects of TXA (i.e., venous thrombotic event (VTE)) and mortality. RESULTS In total, 101 patients were analyzed and received TXA (n = 49) or placebo (n = 52). There was no statistically significant difference in hemostatic clip devices used in both groups (69% versus 83%, p = 0.161). TXA administration showed significant positive changes in hemoglobin levels (millimoles per Liter; 0.55 versus 0.80, p = 0.013), in heart rate (beats per minute; -4.6 versus 2.5; p = 0.013), in minor complications (Clavien-Dindo ≤ 2, 2.0% versus 17.3%, p = 0.016), and in mean LOS (hours; 30.8 versus 36.7, p = 0.013). One patient in the placebo-group underwent radiological intervention for postoperative hemorrhage. No VTE or mortality was reported. CONCLUSION This study did not demonstrate a statistically significant difference in use of hemostatic clip devices and major complications after peroperative administration of TXA. However, TXA seems to have positive effects on clinical parameters, minor complications, and LOS in patients undergoing SG, without increasing the risk of VTE. Larger studies are needed to investigate the effect of TXA on postoperative major complications.
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Affiliation(s)
- J W H 't Hart
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
- Department of Surgery, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - B J Noordman
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
- Department of Surgery, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - J M A Wijnand
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - L U Biter
- Department of Surgery, Tulp Medisch Centrum, Zwijndrecht, The Netherlands
| | - S J C Verbrugge
- Department of Anesthesiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - E Birnie
- Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - M Dunkelgrun
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - J Huisbrink
- Department of Pharmacology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - J A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
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‘t Hart JW, Leeman M, Mourik BC, Pouw N, Biter LU, Apers JA, Castro Cabezas M, Dunkelgrün M. Neutrophil-to-Lymphocyte Ratio as an Early Predictor for Major Complications After Metabolic Surgery. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Judith W.H. ‘t Hart
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Marjolijn Leeman
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Bas C. Mourik
- Department of Clinical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nadine Pouw
- Department of Clinical Chemistry and Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Laser U. Biter
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Jan A. Apers
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Martin Dunkelgrün
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
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Bozan MB, Kutluer N, Aksu A, Bozan AA, Kanat BH, Böyük A. IS BODY MASS INDEX AND OBESITY SURGERY MORTALITY SCORE IMPORTANT IN PERIOPERATIVE COMPLICATIONS OF LAPAROSCOPIC SLEEVE GASTRECTOMY BEFORE DISCHARGE? ACTA ACUST UNITED AC 2021; 34:e1602. [PMID: 34669891 PMCID: PMC8521821 DOI: 10.1590/0102-672020210002e1602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/13/2021] [Indexed: 12/23/2022]
Abstract
Background:
Morbid obesity surgery and related complications have increased with time.
Aim: To evaluate the relationship between perioperative complications before discharge and preoperative body mass index and obesity surgery mortality score in laparoscopic sleeve gastrectomy.
Method:
1617 patients who met the inclusion criteria were evaluated retrospectively. The patients were examined in terms of demographic data, presence of comorbidities, whether there were complications or not, type of complications and obesity surgery mortality score.
Results:
Complications were seen in 40 patients (2.5%) and mortality wasn’t seen in the early postoperative period before discharge. The mean age of patients with complications was 36.3±10.02 years (19-57) and without complications 34.12±9.54 (15-64) years. The preoperative mean BMI values of patients with and without complications were 45.05±3.93 (40-57) kg/m2 and 44.8±3.49 (35-67) kg/m2 respectively. According to BMI groups 40-45 kg/m2, 45-50 kg/m2 and 50 and over, there was not any statistical significance seen in three groups in terms of complication positivity and major-minor complication rates. There was not any statistical significance seen between the patients with and without major-minor complications and obesity surgery mortality score.
Conclusion:
There was not any relation between perioperative laparoscopic sleeve gastrectomy complication rates before discharge and BMI and obesity surgery mortality scores.
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Affiliation(s)
- Mehmet Buğra Bozan
- Department of Surgery, Kahramanmaras Sutcu Imam University, Professor (Assistant), Kahramanmaras, Turkey
| | - Nizamettin Kutluer
- Department of Surgery, Elazig Training and Research Hospital, Specialist of General Surgery, Elazig, Turkey
| | - Ali Aksu
- Department of Surgery, Elazig Training and Research Hospital, Specialist of General Surgery, Elazig, Turkey
| | - Ayşe Azak Bozan
- Department of Surgery, Malatya Turgut Özal University, Professor (Associate), Malatya, Turkey
| | - Burhan Hakan Kanat
- Department of Anesthesiology and Reanimation, Elazig Training and Research Hospital, Specialist of General Surgery, Elazig, Turkey
| | - Abdullah Böyük
- Department of Surgery, Elazig Training and Research Hospital, Professor, Elazig, Turkey
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Ogilvie JW, Qayyum I, Parker JL, Luchtefeld MA. Use of a standardized discharge checklist with daily post-operative C-reactive protein monitoring does not impact readmission rates after colon and rectal surgery. Int J Colorectal Dis 2021; 36:1271-1278. [PMID: 33543391 DOI: 10.1007/s00384-021-03866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Elevated CRP has been associated with infectious complications after colorectal surgery but has not been evaluated in a prospective fashion as part of a discharge checklist. The objective of this study was to evaluate the effectiveness of a multi-component "discharge criteria checklist" that included daily use of CRP in decreasing hospital readmission rates after colorectal surgery. METHODS This is a prospective before and after study design that included consecutive patients undergoing major colorectal operations at a single university-affiliated community hospital over a 2-year period. The primary outcome was inpatient or emergency department readmission after 30 days. Selected pre- and peri-operative factors associated with readmissions were then examined in a multivariate analysis model. RESULTS The study included a total of 1546 patients. Surgical indications were inflammatory bowel disease (15%), colorectal cancer (24%), and benign disease (60%); 9.5% were emergencies. The readmission rates for each group were similar, 17.3% and 17.0%, for the control and discharge checklist groups, respectively (p=0.88). On multivariate analysis of the discharge checklist group dataset, only age, sex, surgical acuity and operating time were statistically significant risk factors. The difference of median CRP values on the day of discharge of those readmitted compared to those not readmitted (35 vs 32 mg/L) was not statistically significant (p=0.28). CONCLUSIONS The institution of a "discharge checklist" did not impact post-operative hospital readmissions. Not only were readmissions unchanged by the use of a CRP threshold at discharge, but CRP levels at the time of discharge were not associated with readmissions.
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Affiliation(s)
- James W Ogilvie
- Michigan State University-affiliated hospitals, Spectrum Health, Grand Rapids, MI, USA. .,Department of Surgery, Division of Colorectal Surgery, Michigan State University- affiliated hospitals, Spectrum Health, 4100 Lake Dr. SE, Suite 205, Grand Rapids, MI, 49546, USA.
| | - Imad Qayyum
- Michigan State University-affiliated hospitals, Spectrum Health, Grand Rapids, MI, USA.,Department of Surgery, Division of Colorectal Surgery, Michigan State University- affiliated hospitals, Spectrum Health, 4100 Lake Dr. SE, Suite 205, Grand Rapids, MI, 49546, USA
| | - Jessica L Parker
- Michigan State University-affiliated hospitals, Spectrum Health, Grand Rapids, MI, USA.,Department of Surgery, Division of Colorectal Surgery, Michigan State University- affiliated hospitals, Spectrum Health, 4100 Lake Dr. SE, Suite 205, Grand Rapids, MI, 49546, USA
| | - Martin A Luchtefeld
- Michigan State University-affiliated hospitals, Spectrum Health, Grand Rapids, MI, USA.,Department of Surgery, Division of Colorectal Surgery, Michigan State University- affiliated hospitals, Spectrum Health, 4100 Lake Dr. SE, Suite 205, Grand Rapids, MI, 49546, USA
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Wysocki M, Małczak P, Wierdak M, Walędziak M, Hady HR, Diemieszczyk I, Proczko-Stepaniak M, Szymański M, Dowgiałło-Wnukiewicz N, Szeliga J, Pędziwiatr M, Major P. Utility of Inflammatory Markers in Detection of Perioperative Morbidity After Laparoscopic Sleeve Gastrectomy, Laparoscopic Roux-en-Y Gastric Bypass, and One-Anastomosis Gastric Bypass-Multicenter Study. Obes Surg 2021; 30:2971-2979. [PMID: 32347517 PMCID: PMC7305064 DOI: 10.1007/s11695-020-04636-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The most commonly performed bariatric operations are laparoscopic sleeve gastrectomy (LSG) and bypass surgeries (laparoscopic one-anastomosis gastric bypass (OAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB)), and predicting perioperative morbidity is crucial for early, safe patient discharge. We aimed to determine whether C-reactive protein (CRP) and white blood count (WBC) measured on the first postoperative day predicts perioperative morbidity in the first 30-days after LSG and bypass surgeries. Methods We retrospectively analyzed data for 1400 patients who underwent bariatric surgery in seven bariatric centers from 2014 to 2018. Patients were divided into a complicated group (patients with postoperative complications) and a non-complicated group. We also performed separate analyses for LSG and bypass surgeries. Results Patients were 929 women (66%) and 471 men (34%) with a median age of 42 years (range, 35–51 years); 1192 patients underwent LSG (85%), 120 underwent LRYGB (9%), and 80 underwent OAGB (6%). We performed ROC analyses to set cut-off points, followed by multivariate logistic regressions. CRP > 33.32 mg/L increased the odds ratio (OR) of perioperative complications after LSG 2.27 times, while WBC > 12.15 × 103/μL on postoperative day 1 was associated with a 3.34-times greater or of developing complications. WBC > 13.78 × 103/μL was associated with a 13.34-times higher or of perioperative morbidity in patients undergoing bypass surgeries. Conclusion Even slightly elevated CRP and WBC on postoperative day 1 should alert surgeons to the potential risk of perioperative morbidity.
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Affiliation(s)
- Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Hady Razak Hady
- First Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Inna Diemieszczyk
- First Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Szymański
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Jacek Szeliga
- Department of General, Gastroenterological, and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, Torun, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland.
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Batistini HC, de Sant'Anna ALGG, Dellacrode Giovanazzi RS, Rosa de Freitas V, Martins da Costa SAC, Machado RC. Checklist validation for care provided to patients in the immediate postoperative period of cardiac surgery. J Clin Nurs 2020; 29:4171-4179. [PMID: 32761985 DOI: 10.1111/jocn.15446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
AIMS AND OBJECTIVES We created and validated a checklist for nursing care of patients in the immediate postoperative period of cardiac surgery. BACKGROUND Cardiovascular diseases (CVD) account for about 30% of all deaths recorded in Brazil. There is an arsenal of clinical and surgical treatments for CVD, with a significant number of patients evolving to surgical treatment. Thus, health professionals working in the perioperative period of cardiovascular surgeries need to be updated, trained and qualified to provide adequate and safe care to patients. DESIGN We developed a checklist that defined essential parameters for quality care, to ensure greater agility and patient safety. METHODS This methodology validation study comprised two stages: checklist creation for care provided by nurses to patients in the IPO of cardiac surgery, and content validation using the Delphi method. Participants were selected through an advanced survey conducted on the Lattes Platform website of the National Council for Scientific and Technological Development. The STROBE checklist was used to guide the study. RESULTS Three rounds of analysis by specialists resulted in average CVIs of: 95.8% for objectivity, 97.9% for simplicity, 91.0% for clarity, 93.1% for relevance and 96.5% for variety, suggesting high agreement among specialists. CONCLUSIONS The checklist focused on nursing care of patients in the IPO of cardiac surgery and was validated with three topics, four categories, 16 items and 86 sub-items of care assignments to be applied in clinical practice. RELEVANCE TO CLINICAL PRACTICE This is a validated instrument that guides nurses' actions by admitting postoperative cardiac surgery patients to the ICU based on evidence, which provides more scientific and professional support to health teams' performance, with the objective of strengthening roles and establishing routines; thus presenting a powerful tool for planning nursing actions, providing quality care to patients, and facilitating communication between teams, thereby minimising risks.
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Affiliation(s)
| | - Ana Lucia Gargione Galvão de Sant'Anna
- Graduate Program in Nursing, Federal University of São Carlos, São Paulo, Brazil.,Paulista School of Nursing, Federal University of São Paulo, Health Technology and Innovation Research Laboratory-LAPeTIS, São Paulo, Brazil
| | - Rosemeire Simone Dellacrode Giovanazzi
- Paulista School of Nursing, Federal University of São Paulo, Health Technology and Innovation Research Laboratory-LAPeTIS, São Paulo, Brazil.,UNOESTE College of Medicine Jaú Campus, Presidente Prudente, São Paulo, Brazil.,Faculty of Medicine UNOESTE Campus Jaú, Presidente Prudente, São Paulo, Brazil
| | | | - Suelen Alves Creste Martins da Costa
- Paulista School of Nursing, Federal University of São Paulo, Health Technology and Innovation Research Laboratory-LAPeTIS, São Paulo, Brazil.,UNOESTE College of Medicine Jaú Campus, Presidente Prudente, São Paulo, Brazil.,Faculty of Medicine UNOESTE Campus Jaú, Presidente Prudente, São Paulo, Brazil
| | - Regimar Carla Machado
- Graduate Program in Nursing, Federal University of São Carlos, São Paulo, Brazil.,Paulista School of Nursing, Federal University of São Paulo, Health Technology and Innovation Research Laboratory-LAPeTIS, São Paulo, Brazil.,Paulista School of Nursing, Federal University of São Paulo, São Paulo, Brazil
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8
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A Review of Enhanced Recovery Protocols in Pelvic Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Mannaerts GHH, Allatif REA, Al Hashmi FY, Bhosale A, Hammo AN, Isied SH, Qureshi WA, Al Hamad OS, Kayyal Y, Al Afari HST. First Successful Large-Scale Introduction of an Enhanced Recovery after Bariatric Surgery (ERABS) Program in the Middle East: The Results and Lessons Learned of Tawam Hospital/Johns Hopkins, a Tertiary Governmental Center in the UAE. Obes Surg 2020; 29:2100-2109. [PMID: 30937877 DOI: 10.1007/s11695-019-03841-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although enhanced recovery after bariatric surgery (ERABS) has proven to be safe and cost-effective, this concept is relatively new in the Middle East. METHODS A retrospective analysis of consecutive registered cohorts of patients who underwent primary and purely laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) were compared before introduction of ERABS (2010-2014) and after ERABS (2015-2017) at Tawam Hospital/Johns Hopkins, the UAE. RESULTS A total of 462 eligible bariatric patients (LSG 414 and LRYGB 48) were operated on before and 1602 (LSG 1436 and LRYGB 166) after introduction of the ERABS. Significant improvements of mean patient time of the patient being within the OR for LSG (from 2:27 to 1:23 min, p = 0.000) and LRYGB (from 3:17 to 1:59 min, p = 0.000) were achieved when comparing pre-ERABS with after introduction of ERABS. Furthermore, there was a significant decrease in LOS in both LSG (from 3.2 to 1.5 days, p = 0.000) and in LRYGB (from 3.5 to 1.7 days, p = 0.000). Major (CD classification III-IV) complications decreased significantly in LSG (from 13.8 to 0.8%, p = 0.000) and were similar in LRYGB (from 4.2% to 3.0%, p = NS). The readmission rate for LSG (from 2.9 to 2.6%, p = NS) or LRYGB (from 0 to 4.8%, p = NS) and the reoperation rates after LSG (from 0.7 to 0.5%, p = NS) and LRYGB (from 0 to 2.4%, p = NS) did not differ between both groups following introduction of ERABS. CONCLUSIONS Implementation of a standardized ERABS program in the Middle East is feasible and safe and leads to reduced LOS and OR times.
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Affiliation(s)
- Guido H H Mannaerts
- Department of Surgery, Tawam Hospital/Johns Hopkins, P.O. Box 15258, Al Ain, United Arab Emirates.
| | - Rowaa E A Allatif
- Department of Surgery, Tawam Hospital/Johns Hopkins, P.O. Box 15258, Al Ain, United Arab Emirates
| | - Fatima Y Al Hashmi
- Department of Surgery, Tawam Hospital/Johns Hopkins, P.O. Box 15258, Al Ain, United Arab Emirates
| | - Arati Bhosale
- Department of Anesthesia, Tawam Hospital/Johns Hopkins, Al Ain, United Arab Emirates
| | - Ahmad N Hammo
- Department of Surgery, Tawam Hospital/Johns Hopkins, P.O. Box 15258, Al Ain, United Arab Emirates
| | - Sujoud H Isied
- Department of Surgery, Tawam Hospital/Johns Hopkins, P.O. Box 15258, Al Ain, United Arab Emirates
| | - Warda A Qureshi
- Department of Surgery, Tawam Hospital/Johns Hopkins, P.O. Box 15258, Al Ain, United Arab Emirates
| | - Omar S Al Hamad
- Department of Anesthesia, Tawam Hospital/Johns Hopkins, Al Ain, United Arab Emirates
| | - Yasser Kayyal
- Department of Surgery, Tawam Hospital/Johns Hopkins, P.O. Box 15258, Al Ain, United Arab Emirates
| | - Hmouda S T Al Afari
- Department of Surgery, Tawam Hospital/Johns Hopkins, P.O. Box 15258, Al Ain, United Arab Emirates
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Leeman M, van Mil SR, Biter LU, Apers JA, Verhoef K, Dunkelgrun M. Reducing complication rates and hospital readmissions while revising the enhanced recovery after bariatric surgery (ERABS) protocol. Surg Endosc 2020; 35:612-619. [PMID: 32052150 DOI: 10.1007/s00464-020-07422-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND To optimize the postoperative phase following bariatric surgery, the enhanced recovery after bariatric surgery pathway (ERABS) has been developed. The aim of ERABS is to create a care path that is as safe, efficient and patient-friendly as possible. Continuous evaluation and optimization of ERABS are important to ensure a safe treatment path and may result in better outcomes. The objective of this study was to compare the clinical outcomes of patients undergoing bariatric surgery over 2014-2017, during which the ERABS protocol was continuously evaluated and optimized. METHODS This is a retrospective cohort study. Data were collected from patients undergoing a primary Roux-en-Y gastric bypass or sleeve gastrectomy between January 2014 and December 2017. Outcomes were early complications, unplanned hospital revisits, readmissions, duration of surgery and length of hospital stay. RESULTS 2889 patients underwent a primary bariatric procedure in a single center. There was a significant decrease in minor complications over the years from 7.0 to 1.9% (p < 0.001). Hospital revisit rates decreased after 2015 (p < 0.001). Readmission rates decreased over time (p < 0.001). The mean duration of surgery decreased from 52 (in 2014) to 41 (in 2017) minutes (p < 0.001). Median length of hospital stay decreased from 1.8 to 1.5 days in 2015 (p = 0.002) and remained stable since. CONCLUSION An improvement of the ERABS protocol was associated with a decrease in minor complication rates, number of unplanned hospital revisits and readmission rates after primary bariatric procedures.
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Affiliation(s)
- Marjolijn Leeman
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
| | - Stefanie R van Mil
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - L Ulas Biter
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Jan A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Kees Verhoef
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martin Dunkelgrun
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
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Leeman M, Biter LU, Apers JA, Birnie E, Verbrugge S, Verhoef C, Dunkelgrun M. A Single-Center Comparison of Extended and Restricted THROMBOPROPHYLAXIS with LMWH after Metabolic Surgery. Obes Surg 2019; 30:553-559. [DOI: 10.1007/s11695-019-04188-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kizilcik N, Koner O. Magnesium Sulfate Reduced Opioid Consumption in Obese Patients Undergoing Sleeve Gastrectomy: a Prospective, Randomized Clinical Trial. Obes Surg 2018; 28:2783-2788. [DOI: 10.1007/s11695-018-3243-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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