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Surve A, Cottam D, Pryor A, Cottam S, Michaelson R, Umbach T, Williams M, Bagshahi H, July L, Bueno R, Chock D, Apel M, Hart C, Johnson W, Curtis B, Rosenbluth A, Spaniolas K, Medlin W, Wright W, Lee C, Lee C, Trujeque R, Rinker D. A Prospective Multicenter Standard of Care Study of Outpatient Laparoscopic Sleeve Gastrectomy. Obes Surg 2024; 34:1122-1130. [PMID: 38366263 PMCID: PMC11026234 DOI: 10.1007/s11695-024-07094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
A global shift is occurring as hospital procedures move to ambulatory surgical settings. Surgeons have performed outpatient sleeve gastrectomy (SG) in bariatric surgery since 2010. However, prospective trials are needed to ensure its safety before widespread adoption. PURPOSE The study aimed to present a comprehensive report on the prospective data collection of 30-day outcomes of outpatient primary laparoscopic SG (LSG). This trial seeks to assess whether outpatient LSG is non-inferior to hospital-based surgery in selected patients who meet the outpatient surgery criteria set by the American Society for Metabolic and Bariatric Surgery. MATERIALS AND METHODS This study is funded by the Society of American Gastrointestinal and Endoscopic Surgeons and has been approved by the Advarra Institutional Review Board (Pro00055990). Cognizant of the necessity for a prospective approach, data collection commenced after patients underwent primary LSG procedures, spanning from August 2021 to September 2022, at six medical centers across the USA. Data centralization was facilitated through ArborMetrix. Each center has its own enhanced recovery protocols, and no attempt was made to standardize the protocols. RESULTS The analysis included 365 patients with a mean preoperative BMI of 43.7 ± 5.7 kg/m2. Rates for 30-day complications, reoperations, readmissions, emergency department visits, and urgent care visits were low: 1.6%, .5%, .2%, .2%, and 0%, respectively. Two patients (0.5%) experienced grade IIIb complications. There were no mortalities or leaks reported. CONCLUSION The prospective cohort study suggests that same-day discharge following LSG seems safe in highly selected patients at experienced US centers.
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Affiliation(s)
- Amit Surve
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA.
| | - Aurora Pryor
- Stony Brook University Hospital, 23 South Howell Ave, Centereach, NY, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Robert Michaelson
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Thomas Umbach
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Michael Williams
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | | | - Laura July
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Racquel Bueno
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Devorah Chock
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Matthew Apel
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Christopher Hart
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - William Johnson
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Brendon Curtis
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Amy Rosenbluth
- Stony Brook University Hospital, 23 South Howell Ave, Centereach, NY, USA
| | | | - Walter Medlin
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Whitney Wright
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Ciara Lee
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Christy Lee
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | | | - Deborah Rinker
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
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Weinberg L, Scurrah N, Neal-Williams T, Zhang W, Chen S, Slifirski H, Liu DS, Armellini A, Aly A, Clough A, Lee DK. The transit of oral premedication beyond the stomach in patients undergoing laparoscopic sleeve gastrectomy: a retrospective observational multicentre study. BMC Surg 2023; 23:335. [PMID: 37924061 PMCID: PMC10625241 DOI: 10.1186/s12893-023-02246-6] [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: 07/14/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Antiemetic and analgesic oral premedications are frequently prescribed preoperatively to enhance recovery after laparoscopic sleeve gastrectomy. However, it is unknown whether these medications transit beyond the stomach or if they remain in the sleeve resection specimen, thereby negating their pharmacological effects. METHODS A retrospective cohort study was performed on patients undergoing laparoscopic sleeve gastrectomy and receiving oral premedication (slow-release tapentadol and netupitant/palonosetron) as part of enhanced recovery after bariatric surgery program. Patients were stratified into the Transit group (premedication absent in the resection specimen) and Failure-to-Transit group (premedication present in the resection specimen). Age, sex, body mass index, and presence of diabetes were compared amongst the groups. The premedication lead time (time between premedications' administration and gastric specimen resection), and the premedication presence or absence in the specimen was evaluated. RESULTS One hundred consecutive patients were included in the analysis. Ninety-nine patients (99%) were morbidly obese, and 17 patients (17%) had Type 2 diabetes mellitus. One hundred patients (100%) received tapentadol and 89 patients (89%) received netupitant/palonosetron. One or more tablets were discovered in the resected specimens of 38 patients (38%). No statistically significant differences were observed between the groups regarding age, sex, diabetes, or body mass index. The median (Q1‒Q3) premedication lead time was 80 min (57.8‒140.0) in the Failure-to-Transit group and 119.5 min (85.0‒171.3) in the Transit group; P = 0.006. The lead time required to expect complete absorption in 80% of patients was 232 min (95%CI:180‒310). CONCLUSIONS Preoperative oral analgesia and antiemetics did not transit beyond the stomach in 38% of patients undergoing laparoscopic sleeve gastrectomy. When given orally in combination, tapentadol and netupitant/palonosetron should be administered at least 4 h before surgery to ensure transition beyond the stomach. Future enhanced recovery after bariatric surgery guidelines may benefit from the standardization of premedication lead times to facilitate increased absorption. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry; number ACTRN12623000187640; retrospective registered on 22/02/2023.
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Affiliation(s)
- Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, Australia.
- Department of Critical Care, The University of Melbourne, Austin Health, Heidelberg, Australia.
| | - Nick Scurrah
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | | | - Wendell Zhang
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Sharon Chen
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Hugh Slifirski
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - David S Liu
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Australia
- General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Australia
| | | | - Ahmad Aly
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Australia
| | - Anthony Clough
- Department of Surgery, Box Hill Hospital, Box Hill, Australia
- Melbourne Centre for Bariatric Surgery, Melbourne, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Motola D, Lind R, Geisel L, Aghazarian G, Ghanem M, Teixeira AF, Jawad MA. Implementing novel modalities into an institutional enhanced recovery after bariatric surgery (ERABS) protocol. Surg Endosc 2023:10.1007/s00464-023-10027-8. [PMID: 37017770 DOI: 10.1007/s00464-023-10027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/12/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Enhanced recovery after bariatric surgery pathways are associated with improved postoperative outcomes. This study aims to assess efficacy and safety of three novel protocol contributions (transversus abdominis plane blocks, ketamine and fosaprepitant), as well as their impact on length of stay (LOS) and on postoperative complications. METHODS Effectiveness and safety were retrospectively investigated in patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) over a 6-year period in a single institution. Group 1 patients were not exposed to any of our suggested interventions, whereas Group 2 were exposed to all of three. RESULTS Between January 2015 and August 2021, 1480 patients underwent primary SG (77.6%) or RYGB (22.4%); of those, 1132 (76.5%) and 348 (23.5%) were in Groups 1 and 2, respectively. Mean BMI and age were 45.87 versus 43.65 kg/m2 and 45.53 versus 44.99 years in groups 1 and 2, respectively. Suggested interventions were associated with lower operative times (84.79 ± 24.21 vs. 80.78 ± 32.8 min, p = 0.025). In Group 2, the mean LOS decreased in 0.18 day (1.79 ± 1.04 vs. 1.60 ± 0.90; p = 0.004). Overall complication rates were 8% and 8.6% for groups 1 and 2, respectively; readmission rates were 5.7% (64 pts) vs. 7.2% (25 pts), p > 0.05. Reoperations were less prevalent in Group 2 (1.5% vs. 1.1%; p = 0.79). CONCLUSION Focus on optimized pain management, allied to a superior PONV control, may be relevant contributors for a lower LOS without negative impacts in complications rates.
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Affiliation(s)
- David Motola
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Romulo Lind
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA.
| | - Lauren Geisel
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Gary Aghazarian
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Muhammad Ghanem
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Muhammad A Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
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Demirpolat MT, Şişik A, Yildirak MK, Basak F. Enhanced Recovery After Surgery Promotes Recovery in Sleeve Gastrectomy: A Randomized Controlled Trial. J Laparoendosc Adv Surg Tech A 2022; 33:452-458. [PMID: 36576984 DOI: 10.1089/lap.2022.0494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: The most popular approach for treating obesity is laparoscopic sleeve gastrectomy (LSG). The enhanced recovery after surgery (ERAS) protocol aims to reduce the patient's surgical stress response, optimize their physiological function, and facilitate recovery. The purpose of this study was to investigate the efficacy and safety of the ERAS protocol in patients who have undergone LSG. Methods: Between January 2020 and March 2021, a single-center randomized controlled study with patients undergoing LSG was planned. Patient demographics, duration of surgery and anesthetic induction, postoperative nausea-vomiting (PONV) and pain scores, length of hospital stay, and emergency room readmissions within the first 30 days were also documented. Patients were divided into two groups: those who followed the ERAS protocol and those who did not. The senior surgeon was blinded for the preoperative and postoperative period, whereas the other surgeon was not. The groups were compared in terms of length of hospital stay, duration of surgery, visual analog scale (VAS) scores, PONV effect scores, and emergency service admissions within the first 30 days after surgery. Results: A total of 96 patients were included in this study. Of these, 49 were in the ERAS protocol group and 47 were in the traditional treatment group. The mean age of the patients in the ERAS and traditional treatment groups were 37.47 ± 10.11 years and 35.77 ± 9.62 years, respectively. While the ERAS group patients were hospitalized for a mean of 30.46 ± 11.26 hours, the traditional group patients were hospitalized for 52.02 ± 6.63 hours (P: .001). There was no difference between the groups in terms of the first 30-day readmission to the emergency department (P: .498). Both VAS and PONV effect scores at the 2nd and 12th hours of the ERAS group patients were lower (P: .001, .002, .001, .001, respectively). Conclusions: When compared with the conventional method, the ERAS protocol reduced patient hospitalization time, decreased postoperative nausea, vomiting, and pain scores, and did not vary in postoperative emergency department readmissions. In patients receiving LSG, the ERAS protocol can be employed safely and successfully. Clinical Trial Registration number: NCT04442568.
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Affiliation(s)
- Muhammed Taha Demirpolat
- Department of General Surgery, Umraniye Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Abdullah Şişik
- Department of General Surgery, DrHE Obesity Clinic, Istanbul, Turkey
| | - Muhammed Kadir Yildirak
- Department of General Surgery, Umraniye Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatih Basak
- Department of General Surgery, Umraniye Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Higueras A, Gonzalez G, de Lourdes Bolaños M, Redondo MV, Olazabal IM, Ruiz-Tovar J. Economic Impact of the Implementation of an Enhanced Recovery after Surgery (ERAS) Protocol in a Bariatric Patient Undergoing a Roux-En-Y Gastric Bypass. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14946. [PMID: 36429661 PMCID: PMC9690327 DOI: 10.3390/ijerph192214946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Enhanced Recovery After Surgery (ERAS) protocols have proven to be cost-effective in various surgical procedures, mainly in colorectal surgeries. However, there is still little scientific evidence evaluating the economic impact of their application in bariatric surgery. The present study aimed to compare the economic cost of performing a laparoscopic Roux-en-Y gastric bypass following an ERAS protocol, with the costs of following a standard-of-care protocol. PATIENTS AND METHODS A prospective non-randomized study of patients undergoing Roux-en-Y gastric bypass was performed. Patients were divided into two groups: patients following an ERAS protocol and patients following a standard-of-care protocol. The total costs of the procedure were subdivided into pharmacological expenditures, surgical material, and time expenses, the price of complementary tests performed during the hospital stay, and costs related to the hospital stay. RESULTS The 84 patients included 58 women (69%) and 26 men (31%) with a mean age of 44.3 ± 11.6 years. There were no significant differences in age, gender, and distribution of comorbidities between groups. Postoperative pain, nausea or vomiting, and hospital stay were significantly lower within the ERAS group. The pharmacological expenditures, the price of complementary tests performed during the hospital stay, and the costs related to the hospital stay, were significantly lower in the ERAS group. There were no significant differences in the surgical material and surgical time costs between groups. Globally, the total cost of the procedure was significantly lower in the ERAS group with a mean saving of 1458.62$ per patient. The implementation of an ERAS protocol implied a mean saving of 21.25% of the total cost of the procedure. CONCLUSIONS The implementation of an ERAS protocol significantly reduces the perioperative cost of Roux-en-Y gastric bypass.
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Affiliation(s)
| | | | - Maria de Lourdes Bolaños
- Neuroscience Institute, Centro Universitario de Ciencias Biológico Agropecuarias (CUCBA), University of Guadalajara, Guadalajara 44600, Mexico
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Marinari G, Foletto M, Nagliati C, Navarra G, Borrelli V, Bruni V, Fantola G, Moroni R, Tritapepe L, Monzani R, Sanna D, Carron M, Cataldo R. Enhanced recovery after bariatric surgery: an Italian consensus statement. Surg Endosc 2022; 36:7171-7186. [PMID: 35953683 PMCID: PMC9485178 DOI: 10.1007/s00464-022-09498-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/31/2021] [Indexed: 12/03/2022]
Abstract
Background Enhanced recovery after bariatric surgery (ERABS) is an approach developed to improve outcomes in obese surgical patients. Unfortunately, it is not evenly implemented in Italy. The Italian Society for the Surgery of Obesity and Metabolic Diseases and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care joined in drafting an official statement on ERABS. Methods To assess the effectiveness and safety of ERABS and to develop evidence-based recommendations with regard to pre-, intra-, and post-operative care for obese patients undergoing ERABS, a 13-member expert task force of surgeons and anesthesiologists from Italian certified IFSO center of excellence in bariatric surgery was established and a review of English-language papers conducted. Oxford 2011 Levels of Evidence and U.S. Preventive Services Task Force Grade Definitions were used to grade the level of evidence and the strength of recommendations, respectively. The supporting evidence and recommendations were reviewed and discussed by the entire group at meetings to achieve a final consensus. Results Compared to the conventional approach, ERABS reduces the length of hospital stay and does not heighten the risk of major post-operative complications, re-operations, and hospital re-admissions, nor does it increase the overall surgical costs. A total of 25 recommendations were proposed, covering pre-operative evaluation and care (7 items), intra-operative management (1 item, 11 sub-items), and post-operative care and discharge (6 items). Conclusions ERABS is an effective and safe approach. The recommendations allow the proper management of obese patients undergoing ERABS for a better outcome.
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Affiliation(s)
- Giuseppe Marinari
- Bariatric Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mirto Foletto
- Bariatric Surgery Unit, Azienda Ospedale Università Padova, Padua, Italy
| | - Carlo Nagliati
- Department of Surgery, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Giuseppe Navarra
- Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Vincenzo Bruni
- Bariatric Surgery Unit, Campus Bio Medico University of Rome, Rome, Italy
| | - Giovanni Fantola
- Bariatric Surgery Unit, ARNAS, G. Brotzu Hospital, Cagliari, Italy
| | - Roberto Moroni
- Bariatric Surgery Unit, Policlinico Sassarese, Sassari, Italy
| | - Luigi Tritapepe
- Department of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Monzani
- Department of Anesthesia and Intensive Care Units, Humanitas Research Hospital, Humanitas University Milan, Rozzano, Milan, Italy
| | - Daniela Sanna
- Emergency Department, Section of Anesthesiology and Intensive Care, ARNAS, G. Brotzu Hospital, Cagliari, Italy
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Via V. Gallucci, 13, 35121, Padua, Italy.
| | - Rita Cataldo
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio Medico University of Rome, Rome, Italy
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Abstract
The Enhanced Recovery After Surgery Society published guidelines for bariatric surgery reviewing the evidence and providing specific care recommendations. These guidelines emphasize preoperative nutrition, multimodal analgesia, postoperative nausea and vomiting prophylaxis, anesthetic technique, nutrition, and mobilization. Several studies have since evaluated these pathways, showing them to be safe and effective at decreasing hospital length of stay and postoperative nausea and vomiting. This article emphasizes anesthetic management in the perioperative period and outlines future directions, including the application of Enhanced Recovery After Surgery principles in patients with extreme obesity, diabetes, and metabolic disease and standardization of the pathways to decrease heterogeneity.
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Affiliation(s)
- Christa L Riley
- Fellow, Surgical Critical Care, Department of Anesthesiology and Critical Care, Penn Medicine, 6 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA; Anesthesiologist & Intensivist, Department of Anesthesiology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.
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Factors that Hinder 24-Hour Discharge After Laparoscopic Roux-en-Y Gastric Bypass: a Retrospective Analysis at a Low-Volume Center. Obes Surg 2021; 32:749-756. [PMID: 34806128 PMCID: PMC8606249 DOI: 10.1007/s11695-021-05813-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 12/02/2022]
Abstract
Purpose This study aimed to identify factors that hinder 24-h patient discharge after laparoscopic Roux-en-Y gastric bypass (LRYGB) in a low-volume practice. Material and Methods Consecutive patients who fulfilled regional criteria and underwent primary LRYGB from 2018 to 2020 were retrospectively analyzed. Patients were discharged on the morning of the first postoperative day (POD1) after meeting the predefined criteria. The assessed outcome measures (POD1 vital signs, laboratory findings, pain scores and nausea/vomiting) and 30-day postoperative complications were compared between the early (stay ≤ 24 h) and delayed (>24 h) groups. Results For 107 patients who fulfilled the inclusion criteria, 48 (44.9%) were discharged within 24 h. There were no differences in the baseline demographics, except that the early group was more likely to have a previous abdominal operation (35.4% vs. 16.9%). Both groups had similar operation durations (89 min vs. 92 min), but the early group had a markedly shortened length of stay (23 (24–22) h vs. 27 (47–26) h). The POD1 parameters were the same between the groups, except that the delay group had a significantly higher visual analog scale score, with fewer patient scores of 0. Patients who were younger and female were more likely to need additional IV analgesics. No POD1 antiemesis was required throughout the study. There was no increase in the 30-day complications. Conclusion Patient discharge at 24 h post-LRYGB is feasible and safe in a low-volume practice. A more comprehensive pain relief strategy may be required before generalizing this approach. Graphical abstract ![]()
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Abstract
INTRODUCTION Perioperative enhanced recovery after surgery (ERAS) concepts or fast-track are supposed to accelerate recovery after surgery, reduce postoperative complications and shorten the hospital stay when compared to traditional perioperative treatment. METHODS Electronic search of the PubMed database to identify systematic reviews with meta-analysis (SR) comparing ERAS and traditional treatment. RESULTS The presented SR investigated 70 randomized controlled studies (RCT) with 12,986 patients and 93 non-RCT (24,335 patients) concerning abdominal, thoracic and vascular as well as orthopedic surgery. The complication rates were decreased under ERAS following colorectal esophageal, liver and pulmonary resections as well as after implantation of hip endoprostheses. Pulmonary complications were reduced after ERAS esophageal, gastric and pulmonary resections. The first bowel movements occurred earlier after ERAS colorectal resections and delayed gastric emptying was less often observed after ERAS pancreatic resection. Following ERAS fast-track esophageal resection, anastomotic leakage was diagnosed less often as well as surgical complications after ERAS pulmonary resection. The ERAS in all studies concerning orthopedic surgery and trials investigating implantation of a hip endoprosthesis or knee endoprosthesis reduced the risk for postoperative blood transfusions. Regardless of the type of surgery, ERAS shortened hospital stay without increasing readmissions. CONCLUSION Numerous clinical trials have confirmed that ERAS reduces postoperative morbidity, shortens hospital stay and accelerates recovery without increasing readmission rates following most surgical operations.
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Anxiety and Depression Affect Early Postoperative Pain Dimensions after Bariatric Surgery. J Clin Med 2020; 10:jcm10010053. [PMID: 33375765 PMCID: PMC7801948 DOI: 10.3390/jcm10010053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Uncontrolled postoperative pain and prolonged immobilization after bariatric surgery have been associated with increased postoperative complications and prolonged hospitalization. The aim of our study was to evaluate the postoperative pain that follows bariatric surgery and identify any psychological factors that may affect the early postoperative perception of pain. The study included 100 patients with obesity (women, n = 61; age 37.4 ± 9.9 years, mean ± standard deviation; Body Mass Index (BMI) 47.6 ± 6.5 kg/m2) who underwent bariatric surgery. Preoperative anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale (HADS), and the quantitative and qualitative dimension of early postoperative pain were evaluated by the McGill Pain Questionnaire Short Form (MPQ-SF). Furthermore, the postoperative analgesia protocol was recorded for each patient. Pain declined gradually during the first 24 h postoperative. Although preoperative anxiety had no correlation with the overall pain of postoperative Day 0, patients with a higher level of preoperative anxiety had significantly more intense and more unpleasant pain at 1 h post operation. In addition, depression influences both the intensity and unpleasantness of pain at different time points (1 h, 4 h and 24 h postoperative). Preoperative pain correlated with educational level, but not with age, BMI, gender, marital status, smoking and surgery type. In conclusion, preoperative anxiety and depression influence the early postoperative pain after bariatric surgery, and their preoperative identification is of major importance to enhance the implementation of fast-track postoperative protocols to prevent complications and prolonged hospitalization.
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Vix M, Rodriguez M, Ignat M, Marescaux J, Diana M, Mutter D. Postoperative Remote Monitoring with a Transcutaneous Biosensing Patch: Preliminary Evaluation of Data Collection. Surg Innov 2020; 27:320-327. [PMID: 32524900 DOI: 10.1177/1553350620929461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction. Connected systems transmitting vital parameters could well represent a tool to shorten postoperative hospital stay while providing continuous remote patient monitoring and potentially detect the onset of complications. Our aim was to analyze the functionality of a transcutaneous biosensing data collection patch in morbidly obese patients. Materials and Methods. An adhesive patch (The HealthPatch MD™) was applied to patients' chests postoperatively. The patch was connected to a tablet via a bluetooth network to collect the heart rate, respiratory rate, skin temperature, and posture recognition data. The tablet conveyed data to a secure health data central server by means of a WiFi or 3G/4G transmission. Data were stored in a digital health platform to which health care professionals could connect. The evaluation focused on the volume, quality, and security of data transmission. A pilot phase involved 10 patients. Thirty-three additional patients undergoing bariatric surgery were included in the experimental phase. Results. The mean length of stay was 2.28 days (range: 2-5 days). The mean time of patch application was 51 ± 25.2 hours per patient (range: 19-139 hours), totalizing 1,683 hours of recording for the 33 patients included. During this time, a total of 7.562.531 data measurement points were collected and transmitted to the e-health platform via the patch. Two total disconnections and two partial disconnections were observed. The acquisition of patient postural data was unreliable. Conclusions. Connected telemetry for remote postoperative monitoring is promising. However, it is still limited by data transmission problems.
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Affiliation(s)
- Michel Vix
- IHU-Strasbourg, Institute of Image-Guided Surgery, France.,Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France.,IRCAD, Research Institute against Digestive Cancer, France
| | - Maylis Rodriguez
- Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France
| | - Mihaela Ignat
- Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, France.,IRCAD, Research Institute against Digestive Cancer, France
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, France.,Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France.,IRCAD, Research Institute against Digestive Cancer, France
| | - Didier Mutter
- IHU-Strasbourg, Institute of Image-Guided Surgery, France.,Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France.,IRCAD, Research Institute against Digestive Cancer, France
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Bree K, Mitko J, Hussain L, Tymitz K, Kerlakian G, Meister K. The Impact of an Enhanced Recovery Protocol for Patients Undergoing Laparoscopic Revisional Bariatric Surgery. Obes Surg 2020; 30:2844-2846. [PMID: 32077059 DOI: 10.1007/s11695-020-04493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have been instituted in various subspecialties of surgery. This study aims to provide evidence that ERAS protocols are safe and feasible in revisional bariatric surgery. A retrospective chart review was performed for all patients who underwent conversion from laparoscopic gastric band (LAGB) or sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) from January 2016 to February 2018 at a single independent academic medical center. We calculated the average LOS for these patients as well as the 30-day readmission and 30-day reoperation rates. Median length of stay (LOS) was 1 day (range 1-5) with 92.9% of all patients leaving by postoperative day 3. No patients were readmitted to the hospital within 30 days and none required reoperation.
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Affiliation(s)
- Kevin Bree
- Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, 45220, USA.
| | - John Mitko
- Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, 45220, USA
| | - Lala Hussain
- Trihealth Hatton Research Institute, Cincinnati, OH, USA
| | - Kevin Tymitz
- Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, 45220, USA
| | - George Kerlakian
- Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, 45220, USA
| | - Katherine Meister
- Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, 45220, USA
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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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Abstract
OBJECTIVES Evaluate the safety of fast track (FT) surgery program in patients undergoing primary and revisional bariatric surgery (conversion from one procedure to another); identify limiting factors for early discharge and predictive factors for readmission. METHODS This is a retrospective review of 730 consecutive morbidly obese patients who underwent bariatric surgery between January 2016 and December 2017. Fast track protocol was applied on all patients. Target discharge was after one-night stay. The primary end point is length of stay. The secondary end point is frequency of hospital contact after discharge, readmissions and reinterventions within 30 days. RESULTS Primary procedures (n = 633) were banded Roux-en-Y gastric bypass (BRYGB, 79.3%), sleeve gastrectomy (10.7%), gastric band (4.7%) and others (5.3%). Mean age (± SD) was 44.32 ± 11.26 years, and mean BMI (± SD) was 43.58 ± 6.12 kg/m2. Conversion procedures (n = 97) were gastric band to BRYGB (40.2%), or to adjustable BRYGB (39.2%), Mason to BRYGB (11.3%), sleeve to BRYGB (4.1%) and others (5.2%). Mean age (± SD) was 47.22 ± 9.1 years, and mean BMI (± SD) was 37.9 ± 7.27 kg/m2. Mean LOS in primary patients was 1.3 ± 0.99, and that in conversion patients was 1.5 ± 1.4. Successful discharge at one night or less was achieved in 650 cases (573 primary and 77 conversion). After one-night discharge, incidence of contact to the hospital, readmission and reintervention was 23.9%, 5.9% and 1.9%, in the primary group and 31.2%, 13% and 5.2% in the conversion group. CONCLUSION One-night discharge in FT managed conversion procedures is safe, compared to primary procedures. It is associated with higher readmission rates; however, the postdischarge hospital contacts and surgical complications were not statistically significant different.
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A Single-center Experience Examining the Length of Stay and Safety of Early Discharge After Laparoscopic Roux-en-Y Gastric Bypass Surgery. Obes Surg 2019; 28:1225-1231. [PMID: 29455407 DOI: 10.1007/s11695-017-2993-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study's objective was to describe our experience and evaluate the safety of early discharge (ED) following laparoscopic Roux-en-Y gastric bypass (LRYGB) in a specific patient population. MATERIALS AND METHODS Patients undergoing LRYGB at Montefiore Medical Center were retrospectively reviewed. Patients readmitted in the first 30 days following surgery were compared to those patients who were not readmitted. Data analysis was used to compare groups and to determine factors associated with readmission. In addition to patient demographics, length of stay (LOS) was analyzed as an independent risk factor for readmission. RESULTS A total of 630 LRYGB were performed during this period. There were 5.1% (n = 32) of patients that required readmission within 30 days of discharge. Readmitted patients had a higher BMI (50.0 vs. 45.8; p = 0.006) and there was a trend for them to be younger (38.4 years vs. 42.0; p = 0.07). There was an increased rate of ED in 2015 (36.7%, n = 121) compared to 2014 (29.9%, n = 90). The readmission rate for ED for the study period was 4.7% (n = 10). There were no observed mortalities in our early discharge group of patients. CONCLUSIONS Discharge on post-operative day 1 following a LRYGB is safe and is not associated with an increased likelihood of being readmitted within 30 days of discharge. Our single-center experience helps to better characterize current patient profiles and length of stay trends within the field and can be used to establish a randomized controlled trial for discharging patients early after LRYGB.
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Trotta M, Ferrari C, D’Alessandro G, Sarra G, Piscitelli G, Marinari GM. Enhanced recovery after bariatric surgery (ERABS) in a high-volume bariatric center. Surg Obes Relat Dis 2019; 15:1785-1792. [DOI: 10.1016/j.soard.2019.06.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/16/2019] [Accepted: 06/26/2019] [Indexed: 02/08/2023]
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Same-day discharge on laparoscopic Roux-en-Y gastric bypass patients: an outcomes review. Surg Endosc 2019; 34:3614-3617. [DOI: 10.1007/s00464-019-07139-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023]
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Canadian consensus statement: enhanced recovery after surgery in bariatric surgery. Surg Endosc 2019; 34:1366-1375. [PMID: 31209605 DOI: 10.1007/s00464-019-06911-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Canada, bariatric surgery continues to remain the most effective treatment for severe obesity and its comorbidities. As the number of bariatric surgeries continues to grow, the need for consensus guidelines for optimal perioperative care is imperative. In colorectal surgery, enhanced recovery after surgery (ERAS) protocols were created for this purpose. The objective of this review is to develop evidence-based ERAS guidelines for bariatric surgery. METHODS A literature search of the MEDLINE database was performed using ERAS-specific search terms. Recently published articles with a focus on randomized controlled trials, systematic reviews, and meta-analyses were included. Quality of evidence and recommendations were evaluated using the GRADE assessment system. RESULTS Canadian bariatric surgeons from six provinces and ten bariatric centers performed a review of the evidence surrounding ERAS in bariatric surgery and created consensus guidelines for 14 essential ERAS elements. Our main recommendations were (1) to encourage participation in a presurgical weight loss program; (2) to abstain from tobacco and excessive alcohol; (3) low-calorie liquid diet for at least 2 weeks prior to surgery; (4) to avoid preanesthetic anxiolytics and long-acting opioids; (5) unfractionated or low-molecular-weight heparin prior to surgery; (6) antibiotic prophylaxis with cefazolin ± metronidazole; (7) reduced opioids during surgery; (8) surgeon preference regarding intraoperative leak testing; (9) nasogastric intubation needed only for Veress access; (10) to avoid abdominal drains and urinary catheters; (11) to prevent ileus by discontinuing intravenous fluids early; (12) postoperative analgesia with acetaminophen, short-term NSAIDS, and minimal opioids; (13) to resume full fluid diet on first postoperative day; (14) early telephone follow-up with full clinic follow-up at 3-4 weeks. CONCLUSIONS The purpose of addressing these ERAS elements is to develop guidelines that can be implemented and practiced clinically. ERAS is an excellent model that improves surgical efficiency and acts as a common perioperative pathway. In the interim, this multimodal bariatric perioperative guideline serves as a common consensus point for Canadian bariatric surgeons.
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Ruiz-Tovar J, Garcia A, Ferrigni C, Gonzalez J, Castellon C, Duran M. Impact of implementation of an enhanced recovery after surgery (ERAS) program in laparoscopic Roux-en-Y gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis 2018; 15:228-235. [PMID: 30606469 DOI: 10.1016/j.soard.2018.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The essence of enhanced recovery after surgery (ERAS) program is the multimodal approach, and many authors have demonstrated safety and feasibility in fast-track bariatric surgery. OBJECTIVES The aim of this study was to evaluate the postoperative pain after the implementation of an ERAS protocol in Roux-en-Y gastric bypass and to compare it with the application of a standard care protocol. SETTING University Hospital Rey Juan Carlos, Madrid, Spain. METHODS A prospective randomized clinical trial of all the patients undergoing Roux-en-Y gastric bypass was performed. Patients were randomized into the following 2 groups: those patients after an ERAS program and those patients after a standard care protocol. Postoperative pain, nausea or vomiting, morbidity, mortality, hospital stay, and analytic acute phase reactants 24 hours after surgery were evaluated. RESULTS One hundred eighty patients were included in the study, 90 in each group. Postoperative pain (16 versus 37 mm; P < .001), nausea or vomiting (8.9% versus 2.2%; P = .0498), and hospital stay (1.7 versus 2.8 d; P < .001) were significantly lower in the ERAS group. There were no significant differences in complications, mortality, and readmission rates. White blood cell count, serum fibrinogen, and C reactive protein levels were significantly lower in the ERAS group 24 hours after surgery. CONCLUSION The implementation of an ERAS protocol was associated with lower postoperative pain, reduced incidence of postoperative nausea or vomiting, lower levels of acute phase reactants, and earlier hospital discharge. Complications, reinterventions, mortality, and readmission rates were similar to that obtained after a standard care protocol.
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Affiliation(s)
- Jaime Ruiz-Tovar
- Centro de Excelencia para el Estudio y Tratamiento de la Obesidad, Valladolid, Spain; Department of Surgery. Bariatric Surgery Unit. University Hospital Rey Juan Carlos, Madrid, Spain.
| | - Alejandro Garcia
- Department of Surgery. Bariatric Surgery Unit. University Hospital Rey Juan Carlos, Madrid, Spain
| | - Carlos Ferrigni
- Department of Surgery. Bariatric Surgery Unit. University Hospital Rey Juan Carlos, Madrid, Spain
| | - Juan Gonzalez
- Department of Surgery. Bariatric Surgery Unit. University Hospital Rey Juan Carlos, Madrid, Spain
| | - Camilo Castellon
- Department of Surgery. Bariatric Surgery Unit. University Hospital Rey Juan Carlos, Madrid, Spain
| | - Manuel Duran
- Department of Surgery. Bariatric Surgery Unit. University Hospital Rey Juan Carlos, Madrid, Spain
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Major P, Wysocki M, Torbicz G, Gajewska N, Dudek A, Małczak P, Pędziwiatr M, Pisarska M, Radkowiak D, Budzyński A. Risk Factors for Prolonged Length of Hospital Stay and Readmissions After Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2018; 28:323-332. [PMID: 28762024 PMCID: PMC5778173 DOI: 10.1007/s11695-017-2844-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB) are most commonly performed bariatric procedures. Laparoscopic approach and enhanced recovery after surgery (ERAS) protocols managed to decrease length of hospital and morbidity. However, there are patients in whom, despite adherence to the protocol, the length of stay (LOS) remains longer than targeted. This study aimed to assess potential risk factors for prolonged LOS and readmissions. Methods The study was a prospective observation with a post-hoc analysis of bariatric patients in a tertiary referral university teaching hospital. Inclusion criteria were undergoing laparoscopic bariatric surgery. Exclusion criteria were occurrence of perioperative complications, prior bariatric procedures, and lack of necessary data. The primary endpoints were the evaluations of risk factors for prolonged LOS and readmissions. Results Median LOS was 3 (2–4) days. LOS > 3 days occurred in 145 (29.47%) patients, 79 after LSG (25.82%) and 66 after LRYGB (35.48%; p = 0.008). Factors significantly prolonging LOS were low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence to bariatric center. The risk of hospital readmission rises with occurrence of intraoperative adverse events and low oral fluid intake on the day of surgery on. Conclusions Risk factors for prolonged LOS are low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence. Risk factors for hospital readmission are intraoperative adverse events and low oral fluid intake on the day of surgery.
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Affiliation(s)
- Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Grzegorz Torbicz
- Students' Scientific Group at 2nd Department of Surgery, JUMC, Krakow, Poland
| | - Natalia Gajewska
- Students' Scientific Group at 2nd Department of Surgery, JUMC, Krakow, Poland
| | - Alicja Dudek
- Students' Scientific Group at 2nd Department of Surgery, JUMC, Krakow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland. .,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland. .,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Dorota Radkowiak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Aktimur R, Kirkil C, Yildirim K, Kutluer N. Enhanced recovery after surgery (ERAS) in one-anastomosis gastric bypass surgery: a matched-cohort study. Surg Obes Relat Dis 2018; 14:1850-1856. [PMID: 30545595 DOI: 10.1016/j.soard.2018.08.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/25/2018] [Accepted: 08/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is considered new from the bariatric standpoint. OBJECTIVES To assess the effectiveness and safety of the enhanced recovery after surgery protocol compared with the conventional approach in perioperative care of OAGB patients. SETTING Turkey. METHODS The prospectively collected data of 92 patients managed with standard care (group 1) were compared with 216 patients managed by the enhanced recovery after surgery pathway (group 2). All patients underwent OAGB by the same surgeon. The groups were compared in terms of mean postoperative length of stay; costs for surgery and recovery; and rates of complications, emergency room visits, and readmissions. RESULTS Length of stay was always 5 days in group 1 and had a mean of 1.2 ± 1.3 days in group 2 (P < .001). The mean total cost for surgery and recovery was 858.6 ± 33.1 USD in group 1 and 625.2 ± 289.1 USD in group 2 (P < .001). Specific complications (Clavien-Dindo IIIa) occurred in 1 patient (1.1%) in group 1 and in 3 patients (1.4 %) in group 2 (P = 1.000). Fifty-seven patients (61.9%) in group 1 and 45 (20.9%) in group 2 visited the emergency room within 1 month of being discharged (P < .001). Two patients (.9%) in group 2 needed hospital readmission; there was no need for rehospitalization in group 1 (P < .001). CONCLUSION The enhanced recovery after surgery pathway significantly reduces length of stay and cost after OAGB, with no significant difference in terms of surgical outcomes. It also reduces postdischarge resource utilization.
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Affiliation(s)
- Recep Aktimur
- Istanbul Aydin University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - Cuneyt Kirkil
- Firat University, Faculty of Medicine, Department of General Surgery, Elazig, Turkey
| | - Kadir Yildirim
- Department of General Surgery, Liv Hospital, Samsun, Turkey.
| | - Nizamettin Kutluer
- Department of General Surgery, Elazig Education and Research Hospital, Elazig, Turkey
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Berger I, Xia L, Sperling C, Chelluri R, Taylor B, Pulido J, Guzzo TJ. Next-day discharge after minimally invasive partial nephrectomy: an analysis of the US National Surgical Quality Improvement Program. World J Urol 2018; 37:831-836. [PMID: 30159653 DOI: 10.1007/s00345-018-2469-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 08/24/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Clinical care pathways and new technologies have decreased the length of stay after many surgeries. However, doubt exists about the safety of shorter hospital stays. We sought to evaluate the feasibility of next-day discharge after minimally invasive partial nephrectomy in a national cohort of US patients and surgeons. METHODS Using the National Surgical Quality Improvement Program database, we analyzed patients who underwent minimally invasive partial nephrectomy from 2012 to 2016. Patients were grouped into discharge on post-operative day 1, or discharge on days 2 and 3. Propensity score matching was used to balance patient characteristics and univariable analysis was used to determine the effect of next-day discharge on readmission, post-discharge complications, and major post-discharge complications. RESULTS A total of 8153 patients were included in the analysis and 4430 were matched. The matched cohort was balanced on all patient and peri-operative characteristics. On univariable analysis, no increase in odds were observed in the next-day discharge group for readmission (odds ratio 0.8; 95% confidence interval 0.6-1.4; p = 0.2), post-discharge complications (odds ratio 1.0; 95% confidence interval 0.7-1.4; p = 0.9), or post-discharge major complications (odds ratio 0.9; 95% confidence interval 0.5-1.4; p = 0.6). CONCLUSIONS Next-day discharge in select patients after minimally invasive partial nephrectomy is effectively being utilized by a large, nationwide cohort of surgeons. This approach is feasible in certain patient populations though further research must determine selection criteria for safe next-day discharge.
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Affiliation(s)
- Ian Berger
- Jordan Medical Education Center, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd 6th Floor, Philadelphia, PA, 19104-5162, USA.
| | - Leilei Xia
- Division of Urology, Department of Surgery, Perelman Center for Advanced Medicine West Pavilion, University of Pennsylvania Perelman School of Medicine, 3rd Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104-5162, USA
| | - Colin Sperling
- Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ, 08103, USA
| | - Raju Chelluri
- Division of Urology, Department of Surgery, Perelman Center for Advanced Medicine West Pavilion, University of Pennsylvania Perelman School of Medicine, 3rd Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104-5162, USA
| | - Benjamin Taylor
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, 525 E 68th Street, New York, NY, 10011, USA
| | - Jose Pulido
- Division of Urology, Department of Surgery, Perelman Center for Advanced Medicine West Pavilion, University of Pennsylvania Perelman School of Medicine, 3rd Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104-5162, USA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, Perelman Center for Advanced Medicine West Pavilion, University of Pennsylvania Perelman School of Medicine, 3rd Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104-5162, USA
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Ruiz-Tovar J, Muñoz JL, Royo P, Duran M, Redondo E, Ramirez JM. Implementation of the Spanish ERAS program in bariatric surgery. MINIM INVASIV THER 2018. [PMID: 29519184 DOI: 10.1080/13645706.2018.1446988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction: The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish Fast Track Group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery, comparing it with a historical cohort receiving standard care. Material and methods: A multi-centric prospective study was performed, including 233 consecutive patients undergoing bariatric surgery during 2015 and following ERAS protocol. It was compared with a historical cohort of 286 patients, who underwent bariatric surgery at the same institutions between 2013 and 2014 and following standard care. Compliance with the protocol, morbidity, mortality, hospital stay and readmission were evaluated. Results: Bariatric techniques performed were Roux-en-Y gastric bypass and sleeve gastrectomy. There were no significant differences in complications, mortality and readmission. Postoperative pain and hospital stay were significantly lower in the ERAS group. The total compliance to protocol was 80%. Conclusion: The Spanish National ERAS protocol is a safe issue, obtaining similar results to standard care in terms of complications, reoperations, mortality and readmissions. It is associated with less postoperative pain and earlier hospital discharge.
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Affiliation(s)
- Jaime Ruiz-Tovar
- a Department of Surgery, Bariatric Surgery Unit , University Hospital Rey Juan Carlos , Madrid , Spain
| | - José Luis Muñoz
- b Department of Anaesthesiology , General University Hospital Elche , Alicante , Spain
| | - Pablo Royo
- c Department of Surgery, Bariatric Surgery Unit , Clinical University Hospital Lozano Blesa , Zaragoza , Spain
| | - Manuel Duran
- a Department of Surgery, Bariatric Surgery Unit , University Hospital Rey Juan Carlos , Madrid , Spain
| | - Elisabeth Redondo
- c Department of Surgery, Bariatric Surgery Unit , Clinical University Hospital Lozano Blesa , Zaragoza , Spain
| | - Jose Manuel Ramirez
- c Department of Surgery, Bariatric Surgery Unit , Clinical University Hospital Lozano Blesa , Zaragoza , Spain
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De Gasperi A. Bariatric surgery made light: the Dutch way. Minerva Anestesiol 2018; 84:885-887. [PMID: 29479933 DOI: 10.23736/s0375-9393.18.12810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrea De Gasperi
- Department of Anesthesia and Resuscitation 2, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
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Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: Development of standards for patient safety and efficacy. Metabolism 2018; 79:97-107. [PMID: 29307519 DOI: 10.1016/j.metabol.2017.12.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 12/22/2017] [Accepted: 12/23/2017] [Indexed: 01/03/2023]
Abstract
Weight loss surgery, also referred to as bariatric surgery, has been in existence since the 1950's. Over the decades, it has been demonstrated to successfully achieve meaningful and sustainable weight loss in a large number of patients who undergo these procedures. Additionally, the benefits observed across a number of metabolic disorders such as type 2 diabetes mellitus and hyperlipidemia, are often to a degree, independent of the weight loss, thus the term "metabolic bariatric surgery (MBS)" has become a better descriptor. Throughout its long history, MBS has evolved from an era of high morbidity and mortality to one of laudable safety despite the high-risk nature of the patients undergoing these major gastrointestinal procedures. This article will describe the historic evolution of MBS and concentrate on those events that were instrumental in reducing the morbidity of these operations.
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Affiliation(s)
- Blaine T Phillips
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States; Harvard Medical School, Harvard University, Boston, Massachusetts, United States; Division of Metabolic and Bariatric Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Scott A Shikora
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States; Division of Metabolic and Bariatric Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States.
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Mahmood F, Sharples AJ, Rotundo A, Balaji N, Rao VSR. Factors Predicting Length of Stay Following Bariatric Surgery: Retrospective Review of a Single UK Tertiary Centre Experience. Obes Surg 2018; 28:1924-1930. [DOI: 10.1007/s11695-017-3105-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Vreeswijk SJ, van Rutte PW, Nienhuijs SW, Bouwman RA, Smulders JF, Buise MP. The safety and efficiency of a fast-track protocol for sleeve gastrectomy: a team approach. Minerva Anestesiol 2017; 84:898-906. [PMID: 29239152 DOI: 10.23736/s0375-9393.17.12298-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Increasing numbers of morbid obese patients has led to increased numbers of bariatric procedures. Fast-track protocols are being developed to enhance the available resources, while maintaining a safe procedure. Reported results on safety merely apply to a mixed bariatric population. The objective was to evaluate safety and efficiency of the fast-track principles in patients undergoing sleeve gastrectomy. METHODS Retrospective observational study including patients undergoing primary sleeve gastrectomy at the Obesity Centre of the Catharina Hospital Eindhoven, the Netherlands. Conventional perioperative care (CC) (2008-2011) versus a fast-track protocol (FT) (2011-2013), using short-acting anesthetic agents, a multi-modal pain protocol to reduce opioids, and early mobilization. The main parameters for safety were intraoperative, early and late postoperative complications. Procedure time and hospital stay were used to evaluate efficiency. RESULTS This study included 805 patients, 494 patients were subjected to the conventional care and 318 patients to fast-track protocol. A reduction of median operation time from 60 (CC) to 40 minutes (FT) (P<0.001) and a reduction in median length of hospital stay from three to two days (P=0.001), with a significant reduction in early postoperative complications (9.9% [CC] vs. 5% [FT], P=0.016) was achieved. The amount of late complications was comparable for both groups (5.1% [CC] vs. 4.4% [FT] [P=0.738]). CONCLUSIONS Implementation of a fast-track protocol for sleeve gastrectomy is safe and efficient. It effectively reduces operation time and length of hospital stay, while improving postoperative outcome. This pleads for standard implementation of the fast-track protocol in sleeve gastrectomy.
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Affiliation(s)
| | | | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - J Frans Smulders
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc P Buise
- Intensive Care Unit, Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands -
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Simonelli V, Goergen M, Orlando GG, Arru L, Zolotas CA, Geeroms M, Poulain V, Azagra JS. Fast-Track in Bariatric and Metabolic Surgery: Feasibility and Cost Analysis Through a Matched-Cohort Study in a Single Centre. Obes Surg 2017; 26:1970-7. [PMID: 27272321 DOI: 10.1007/s11695-016-2255-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Due to the rise in severe obesity in Western countries and the increase in bariatric surgery, enhanced recovery (ER) pathways should be developed and promoted. METHODS A monocentric prospective series of 103 bariatric surgery patients managed with the ER pathway (group ER) was compared with a retrospective and immediately previous series of 103 patients managed with standard care (group CS). The aim of the present study was to assess and compare the differences in terms of mean postoperative length of stay (LOS), costs for surgery and recovery, and the differences in terms of complications, readmission, and reoperation rate in the short term between the ER and CS groups. RESULTS The mean LOS was 4.18 days in group CS and 1.79 days in group ER (p < 0.0001). The mean operative time (OT) per patient was 190.20 min in the group CS and 133.54 min in the group ER, resulting in an average cost of 7272.57€ per patient in group CS and 5424.09€ per patient in group ER. The average recovery cost was 1809.94€ for the group CS series and 775.07 for the group ER one. Overall complications (Clavien-Dindo up to II) occurred in 6 patients (5.8 %) in group CS and in 2 patients (1.9 %) in group ER (p = 0.149) and specific complications (Clavien-Dindo IIIb) occurred for 9 patients (8.7 %) in Group CS and for 14 patients (13.5 %) in group ER (p = 0.268) after hospital discharge within 1-month of follow-up. Twelve patients (11.5 %) in group CS and 13 (12.5 %) in group ER were readmitted after discharge (p = 0.831) within 1-month of follow-up; 8 patients (7.7 %) in group CS versus 9 patients (8.8 %) in group ER needed to be reoperated (p = 0.800) within 1-month follow-up. CONCLUSIONS Enhanced recovery pathway reduces significantly LOS in bariatric surgical patients and shortens the mean OT of the procedure, with no significant differences in terms of surgical outcomes. Furthermore, recovery charges were lower and operative time was shorter allowing for procedural cost reduction.
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Affiliation(s)
- Vincenzo Simonelli
- Centre Hospitalier de Luxembourg, 4 Rue Barblé, L-1210, Luxembourg City, Grand Duchy of Luxembourg.
| | - Martine Goergen
- Centre Hospitalier de Luxembourg, 4 Rue Barblé, L-1210, Luxembourg City, Grand Duchy of Luxembourg
| | - Gennaro G Orlando
- Centre Hospitalier de Luxembourg, 4 Rue Barblé, L-1210, Luxembourg City, Grand Duchy of Luxembourg
| | - Luca Arru
- Centre Hospitalier de Luxembourg, 4 Rue Barblé, L-1210, Luxembourg City, Grand Duchy of Luxembourg
| | - Charalampos A Zolotas
- Centre Hospitalier de Luxembourg, 4 Rue Barblé, L-1210, Luxembourg City, Grand Duchy of Luxembourg
| | - Maxim Geeroms
- Centre Hospitalier de Luxembourg, 4 Rue Barblé, L-1210, Luxembourg City, Grand Duchy of Luxembourg
| | - Virginie Poulain
- Centre Hospitalier de Luxembourg, 4 Rue Barblé, L-1210, Luxembourg City, Grand Duchy of Luxembourg
| | - Juan S Azagra
- Centre Hospitalier de Luxembourg, 4 Rue Barblé, L-1210, Luxembourg City, Grand Duchy of Luxembourg.
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Małczak P, Pisarska M, Piotr M, Wysocki M, Budzyński A, Pędziwiatr M. Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis. Obes Surg 2017; 27:226-235. [PMID: 27817086 PMCID: PMC5187372 DOI: 10.1007/s11695-016-2438-z] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocol is well established in many surgical disciplines and leads to a decrease in the length of hospital stay and morbidity. Multimodal protocols have also been introduced to bariatric surgery. This review aims to evaluate the current literature on ERAS in obesity surgery and to conduct a meta-analysis of primary and secondary outcomes. MEDLINE, Embase, Scopus and Cochrane Library were searched for eligible studies. Key journals were hand-searched. We analysed data up to May 2016. Eligible studies had to contain four described ERAS protocol elements. The primary outcome was the length of hospital stay; the secondary outcomes included overall morbidity, specific complications, mortality, readmissions and costs. Random effect meta-analyses were undertaken. The initial search yielded 1151 articles. Thorough evaluation resulted in 11 papers, which were analysed. The meta-analysis of the length of stay presented a significant reduction standard mean difference (Std. MD) = −2.39 (−3.89, −0.89), p = 0.002. The analysis of overall morbidity, specific complications and Clavien-Dindo classification showed no significant variations among the study groups. ERAS protocol in bariatric surgery leads to the reduction of the length of hospital stay while maintaining no or low influence on morbidity.
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Affiliation(s)
- Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Major Piotr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland. .,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
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Zhang L, Scott J, Shi L, Truong K, Hu Q, Ewing JA, Chen L. Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014. PLoS One 2017; 12:e0186306. [PMID: 29053709 PMCID: PMC5650154 DOI: 10.1371/journal.pone.0186306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/28/2017] [Indexed: 11/22/2022] Open
Abstract
Background With the epidemic of morbid obesity, bariatric surgery has been accepted as one of the most effective treatments of obesity. Objective To investigate recent changes in the utilization of bariatric surgery, patients and hospital characteristics, and in-hospital complications in a nationwide hospital database in the United States. Setting This is a secondary data analysis of the Premier Perspective database. Methods ICD-9 codes were used to identify bariatric surgeries performed between 2011 and 2014. Descriptive statistics were computed and regression was used. Results A total of 74,774 bariatric procedures were identified from 436 hospitals between 2011 and 2014. During this time period, the proportion of gastric bypass (from 44.8% to 31.3%; P for trend < 0.0001) and gastric banding (from 22.8% to 5.2%; P for trend < 0.0001) decreased, while the proportion of sleeve gastrectomy (from 13.7% to 56.9%; P for trend < 0.0001) increased substantially. The proportion of bariatric surgery performed for outpatients decreased from 17.15% in 2011 to 8.11% in 2014 (P for trend < 0.0001). The majority of patients undergoing surgery were female (78.5%), white (65.6%), younger than 65 years (93.8%), and insured with managed care (53.6%). In-hospital mortality rate and length of hospital stay remained stable. The majority of surgeries were performed in high-volume (71.8%) and urban (91.6%) hospitals. Conclusions Results based on our study sample indicated that the popularity of various bariatric surgery procedures changed significantly from 2011 to 2014. While the rates of in-hospital complications were stable, disparities in the use of bariatric surgery regarding gender, race, and insurance still exist.
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Affiliation(s)
- Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - John Scott
- Department of Surgery, Greenville Health System, Greenville, South Carolina, United States of America
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Khoa Truong
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Qingwei Hu
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Joseph A. Ewing
- Department of Surgery, Greenville Health System, Greenville, South Carolina, United States of America
| | - Liwei Chen
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
- * E-mail:
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Dupanovic M, Krebill R, Dupanovic I, Nachtigal J, Rockford M, Orr W. Perioperative Factors Affecting Ambulatory Outcomes Following Laparoscopic-Adjustable Gastric Banding. Turk J Anaesthesiol Reanim 2017; 45:282-288. [PMID: 29114413 DOI: 10.5152/tjar.2017.70037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/06/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Morbidly obese patients are traditionally hospitalised following bariatric surgery. However, laparoscopic-adjustable gastric banding (LAGB) is amenable for ambulatory care. We hypothesised that the majority of patients can receive an ambulatory LAGB and that both surgical and anaesthetic perioperative factors will significantly affect non-ambulatory LAGB outcomes. Methods Medical records of 201 consecutive LAGB patients performed at the University of Kansas Medical Centre during a 3-y period were reviewed. Demographic, medical, laboratory, anaesthetic, intraoperative and postoperative data were collected. Factors associated with non-ambulatory outcomes were identified and analysed using logistic regression, and a classification tree analysis was used to rank the descriptive model factor to the non-ambulatory outcome. Results Average patient age was 43.4±11.4 years, and average body mass index was 48.2±10.3 kg m2-1. A total of 155 patients (77.1%; 95% confidence interval, 71%-83%; p<0.0001) were discharged home within 2-3 hours of surgery, whereas 36 stayed for 23 hours and 10 required hospital admission for 1-2 days. Increased surgical port numbers (p=0.007), ≥50% of total intraoperative fentanyl administered in the recovery room (post-anaesthesia care unit) for the treatment of postoperative pain (p=0.007) and a lack of prophylactic beta-blockade (p=0.001) were three factors associated with non-ambulatory outcomes. Obstructive sleep apnoea was not associated with a non-ambulatory outcome (p=0.83). Conclusion The majority of patients received an ambulatory LAGB. Meticulous laparoscopic surgical technique with the least feasible number of access ports and multimodal analgesic technique aimed at reduction of postoperative opioid consumption are the most important factors for a successful ambulatory LAGB outcome.
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Affiliation(s)
- Mirsad Dupanovic
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ron Krebill
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - John Nachtigal
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Melissa Rockford
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Walter Orr
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Molina JC, Misariu AM, Nicolau I, Spicer J, Mulder D, Ferri LE, Mueller CL. Same day discharge for benign laparoscopic hiatal surgery: a feasibility analysis. Surg Endosc 2017; 32:937-944. [PMID: 28779258 DOI: 10.1007/s00464-017-5769-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/14/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Advances in minimally invasive surgery and the development of enhanced recovery pathways have favored the spread of day-surgery programs. Despite laparoscopic approaches being accepted as the standard of care for benign hiatal diseases, safety and feasibility of same day discharges for laparoscopic hiatal surgeries other than fundoplication has yet to be established. OBJECTIVE This study aimed to assess the feasibility of same day discharge for primary and revisional laparoscopic hiatal surgeries including paraesophageal hernia repairs (PEHR), fundoplication for reflux, and Heller myotomy (±diverticulectomy). METHODS A retrospective cohort study including all patients undergoing elective laparoscopic hiatal procedures in the division of Thoracic surgery between 2011 and 2016 at McGill University Health Centre was performed. Planned day-surgery (DAYCASE) was compared to planned inpatient (INPATIENT) cohorts with respect to operative and postoperative outcomes, length of stay, readmission, and emergency room visits. RESULTS A total of 261 patients were identified, 161 female (62%); median age 62 (20). The case distribution was: PEHR (123; 47.1%), Heller myotomy (94;36%, 7 diverticulectomy), and fundoplication (44; 16.9%). Twenty patients had revisional procedures (7.7%). Same day discharge was planned in 98 cases (38%) and was successful in 80 (81.6%). Proportion of DAYCASE increased form 12% prior to 2013 to 67% in 2016. INPATIENTs were older (median 66 vs. 60 years), and had a higher proportion of PEHR (55 vs. 34%), p < 0.05. Both cohorts were comparable in gender proportion, ASA classification, and length of surgery. Complications, readmission, and emergency visits did not differ between the two cohorts. On multivariate analysis, female gender (OR 37, 95% CI 1.46-936, p = 0.028), surgery beginning after noon (OR 5.4, 95% CI 1.1-26.9, p = 0.038), intraoperative complications (OR 20.4 95% CI 1.5-286, p = 0.025), and postoperative complications (OR 52.1, 95% CI 4.5-602, p = 0.002) were independently associated with unplanned admission. CONCLUSIONS Day-case surgery for complex laparoscopic hiatal procedures is feasible and can be achieved in a significant number of patients without compromising safety.
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Affiliation(s)
- Juan Carlos Molina
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada.
| | - Ana María Misariu
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Ioana Nicolau
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - David Mulder
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Lorenzo E Ferri
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Carmen L Mueller
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
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Diagnostic Performance of C-Reactive Protein in Detecting Post-Operative Infectious Complications After Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 27:3124-3132. [DOI: 10.1007/s11695-017-2744-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Nikniaz Z, Somi MH, Nagashi S, Nikniaz L. Impact of Early Enteral Nutrition on Nutritional and Immunological Outcomes of Gastric Cancer Patients Undergoing Gastrostomy: A Systematic Review and Meta-Analysis. Nutr Cancer 2017; 69:693-701. [PMID: 28569563 DOI: 10.1080/01635581.2017.1324996] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The present systematic review and meta-analysis study evaluated the impact of early enteral nutrition (EN) on postoperative nutritional and immunological outcomes of gastric cancer (GC) patients. METHOD The databases of PubMed, Embase, Springer, and Cochrane library were searched till September 2016 to identify studies which evaluated the effects of EN compared with parenteral nutrition (PN) on postoperative immunological and nutritional status and hospitalization time in GC patients. Mean difference (MD) or standard mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity analysis. RESULTS The present systematic review and meta-analysis have consisted of seven trials, containing 835 GC patients. According to the result of meta-analysis, compared with PN, EN significantly resulted in more increase in the level of albumin [MD = 2.07 (0.49, 3.64)], prealbumin [MD = 9.41 (049, 33.55)], weight [MD = 1.52 (0.32, 2.72)], CD3+ [SMD = 1.96 (1.50, 2.43)], CD4+ [SMD = 2.45 (1.97, 2.93)], natural killers [MD = 5.80 (3.75, 7.85)], and also a decrease in the hospitalization time [MD=-2.39 (-2.74, -2.03)]. CONCLUSION The results demonstrated that early administration of EN is more effective in improving postsurgical nutrition status and immune index in GC patients. So, based on these results, postoperative early administration of EN is recommended for GC patients where possible.
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Affiliation(s)
- Zeinab Nikniaz
- a Liver and Gastrointestinal Disease Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Mohammad Hossein Somi
- a Liver and Gastrointestinal Disease Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Shahnaz Nagashi
- a Liver and Gastrointestinal Disease Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Leila Nikniaz
- b Tabriz Health Services Management Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
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Implementation of the Spanish National Enhanced Recovery Program (ERAS) in Bariatric Surgery: A Pilot Study. Surg Laparosc Endosc Percutan Tech 2016; 26:439-443. [DOI: 10.1097/sle.0000000000000323] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morales-Conde S, Del Agua IA, Moreno AB, Macías MS. Postoperative pain after conventional laparoscopic versus single-port sleeve gastrectomy: a prospective, randomized, controlled pilot study. Surg Obes Relat Dis 2016; 13:608-613. [PMID: 28159565 DOI: 10.1016/j.soard.2016.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 10/12/2016] [Accepted: 11/14/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic approach is the gold standard for surgical treatment of morbid obesity. The single-port (SP) approach has been demonstrated to be a safe and effective technique for the treatment of morbid obesity in several case control studies. OBJECTIVES Compare conventional multiport laparoscopy (LAP) with an SP approach for the treatment of morbid obesity using sleeve gastrectomy in terms of postoperative pain using a visual analog scale (VAS) 0-100, surgical outcome, weight loss, and aesthetical satisfaction at 6 months after surgery. SETTING University Hospital, Spain. METHODS Randomized, controlled pilot study. The trial enrolled patients suitable for bariatric surgery, with a body mass index lower than 50 kg/m2 and xiphoumbilical distance lower than 25 cm. Patients were randomly assigned to receive LAP or SP sleeve gastrectomy. RESULTS A total of 30 patients were enrolled; 15 were assigned to LAP group and 15 to SP group. No patients were lost during follow-up. Baseline characteristics were similar in both groups. A significantly higher level of pain during movement was noted for the patients in the LAP group on the first (mean VAS 49.3±12.2 versus 34.1±8.9, P = .046) and second days (mean VAS 35.9±10.2 versus 22.1±7.9, P = .044) but not the third day (mean VAS 20.1±5.2 versus 34.12.9 ±4.3, P = .620). No differences regarding pain at rest, operative time, complications, or weight loss at 6 months were observed. Higher aesthetical satisfaction was noticed in SP group. CONCLUSIONS In selected patients, SP surgery presented less postoperative pain in sleeve gastrectomy compared with the conventional laparoscopic approach with similar surgical results.
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Pike TW, Lodge JPA. Fast-Track Management after Laparoscopic Roux-en-Y Gastric Bypass. J Am Coll Surg 2016; 223:203. [PMID: 27345917 DOI: 10.1016/j.jamcollsurg.2016.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 11/16/2022]
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Dogan K, Kraaij L, Aarts EO, Koehestanie P, Hammink E, van Laarhoven CJHM, Aufenacker TJ, Janssen IMC, Berends FJ. Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care. Obes Surg 2015; 25:28-35. [PMID: 24993524 DOI: 10.1007/s11695-014-1355-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Due to the increased incidence of morbid obesity, the demand for bariatric surgery is increasing. Therefore, the methods for optimising perioperative care for the improvement of surgical outcome and to increase efficacy are necessary. The aim of this prospective matched cohort study is to objectify the effect of the fast-track surgery (FTS) programme in patients undergoing primary Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) surgery compared to conventional perioperative care (CPC). METHODS This study compared the perioperative outcome data of two groups of 75 consecutive morbid obese patients who underwent a primary LRYGB according to international guidelines in the periods January 2011-April 2011 (CPC group) and April 2012-June 2012 (FTS group). The two groups were matched for age and sex. Primary endpoints were surgery and hospitalisation time, while secondary endpoints were intraoperative medication use and complication rates. RESULTS Baseline patient characteristics for age, sex, weight and ASA classification were similar (p > 0.05) for CPC and FTS patients. BMI and waist circumference were significantly lower (p < 0.05) in the FTS compared to CPC. The total time from arrival at the operating room to the arrival at the recovery was reduced from 119 to 82 min (p < 0.001). Surgery time was reduced from 80 to 56 min (p < 0.001); mean hospital stay was reduced from 65 to 43 h (p < 0.001). Major complications occurred in 3 versus 4 % in the FTS and CPC, respectively. CONCLUSIONS The introduction of a fast-track programme after primary LRYGB improves short-term recovery and may reduces direct hospital-related resources.
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Affiliation(s)
- Kemal Dogan
- Department of Surgery, Rijnstate Hospital Arnhem, Intern post number 1190, Post Box 9555, 6800 TA, Arnhem, The Netherlands,
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Hedberg J, Zacharias H, Janson L, Sundbom M. Preoperative Slow-Release Morphine Reduces Need of Postoperative Analgesics and Shortens Hospital Stay in Laparoscopic Gastric Bypass. Obes Surg 2015. [DOI: 10.1007/s11695-015-1817-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Outcome of Laparoscopic Gastric Bypass (LRYGB) with a Program for Enhanced Recovery After Surgery (ERAS). Obes Surg 2015. [DOI: 10.1007/s11695-015-1799-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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The relationship between duration of stay and readmissions in patients undergoing bariatric surgery. Surgery 2015; 158:501-7. [PMID: 26032831 DOI: 10.1016/j.surg.2015.03.051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/05/2015] [Accepted: 03/05/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hospital readmissions are a quality indicator in bariatric surgery. In recent years, duration of stay after bariatric surgery has trended down greatly. We hypothesized that a shorter postoperative hospitalization does not increase the likelihood of readmission. METHODS The University HealthSystem Consortium (UHC) is an alliance of academic medical centers and affiliated hospitals. The UHC's clinical database contains information on inpatient stay and returns (readmissions) up to 30 days after discharge. A multicenter analysis of outcomes was performed by the use of data from the January 2009 to December 2013 for patients 18 years and older. Patients were identified by bariatric procedure International Classification of Diseases, Ninth Revision, codes and restricted by diagnosis codes for morbid obesity. RESULTS A total of 95,294 patients met inclusion criteria. The mean patient age was 45.4 (±0.11) years, and 73,941 (77.6%) subjects were female. There were 5,423 (5.7%) readmissions within the study period. Patients with hospitalizations of 3 days and more than 3 days were twice and four times as likely to be readmitted than those with hospitalizations of one day, respectively (P < .001). CONCLUSION Patients with longer postoperative hospitalizations were more likely to be readmitted after bariatric surgery. Early discharge does not appear to be associated with increased readmission rates.
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Mannaerts GHH, van Mil SR, Stepaniak PS, Dunkelgrün M, de Quelerij M, Verbrugge SJ, Zengerink HF, Biter LU. Results of Implementing an Enhanced Recovery After Bariatric Surgery (ERABS) Protocol. Obes Surg 2015; 26:303-12. [DOI: 10.1007/s11695-015-1742-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Matłok M, Pędziwiatr M, Major P, Kłęk S, Budzyński P, Małczak P. One hundred seventy-nine consecutive bariatric operations after introduction of protocol inspired by the principles of enhanced recovery after surgery (ERAS®) in bariatric surgery. Med Sci Monit 2015; 21:791-7. [PMID: 25779669 PMCID: PMC4373155 DOI: 10.12659/msm.893297] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Obese patients are a very large high-risk group for complications after surgical procedures. In this group, optimized perioperative care and a faster recovery to full activity can contribute to a decreased rate of postoperative complications. The introduction of ERAS®-based protocol is now even more important in bariatric surgery centers. The results of our study support the idea of implementation of ERAS®-based protocol in this special group of patients. Material/Methods This analysis included 170 patients (62 male/108 female, mean BMI 46.7 kg/m2) who had undergone laparoscopic bariatric surgery, and whose perioperative care was conducted according to a protocol inspired by ERAS® principles. Examined factors included oral nutrition tolerance, time until mobilization after surgery, requirements for opioids, duration of hospitalization, and readmission rate. Results During the first 24 postoperative hours, oral administration of liquid nutrition was tolerated by 162 (95.3%) patients and 163 (95.8%) were fully mobile. In 44 (25.8%) patients it was necessary to administer opioids to relieve pain. Intravenous liquid supply was discontinued within 24 hours in 145 (85.3%) patients. The complication rate was 10.5% (mainly rhabdomyolysis and impaired passage of gastric contents). The average time of hospitalization was 2.9 days and the readmission rate was 1.7%. Conclusions The introduction of an ERAS® principles-inspired protocol in our center proved technically possible and safe for our patients, and allowed for reduced hospitalization times without increased rate of complications or readmissions.
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Affiliation(s)
- Maciej Matłok
- 2nd Department of General Surgery, Jagiellonian University - Medical College, Cracow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University - Medical College, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University - Medical College, Cracow, Poland
| | - Stanisław Kłęk
- 2nd Department of General Surgery, Jagiellonian University - Medical College, Cracow, Poland
| | - Piotr Budzyński
- 2nd Department of General Surgery, Jagiellonian University - Medical College, Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery - Students' Society of Science, Jagiellonian University - Medical College, Cracow, Poland
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Sundbom M. Laparoscopic revolution in bariatric surgery. World J Gastroenterol 2014; 20:15135-15143. [PMID: 25386062 PMCID: PMC4223247 DOI: 10.3748/wjg.v20.i41.15135] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/08/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.
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Pike TW, White AD, Snook NJ, Dean SG, Lodge JPA. Simplified Fast-Track Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2014; 25:413-7. [DOI: 10.1007/s11695-014-1408-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Waydia S, Gunawardene A, Gilbert J, Cota A, Finlay IG. 23-Hour/Next Day Discharge Post-Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Surgery Is Safe. Obes Surg 2014; 24:2007-10. [DOI: 10.1007/s11695-014-1409-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Carter J, Elliott S, Kaplan J, Lin M, Posselt A, Rogers S. Predictors of hospital stay following laparoscopic gastric bypass: analysis of 9,593 patients from the National Surgical Quality Improvement Program. Surg Obes Relat Dis 2014; 11:288-94. [PMID: 25443054 DOI: 10.1016/j.soard.2014.05.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/29/2014] [Accepted: 05/08/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bariatric centers face pressure to reduce hospitalization to contain costs, and some centers have sought to develop "fast-track" protocols. There is limited data to identify which patients require a longer hospital stay after gastric bypass, and therefore would be inappropriate for fast tracking. The objectives of this study were to determine (1) whether most patients in the United States who underwent laparoscopic gastric bypass required>1 day of hospitalization to recover; (2) whether hospital length of stay can be predicted by factors known before or after the operation. METHODS We reviewed all laparoscopic gastric bypass operations reported to the American College of Surgeons National Surgical Quality Improvement Program in 2011. Revision and open procedures were excluded. Patient and procedural characteristics, length of stay, readmissions, and 30-day morbidity and mortality were reviewed. Predictors of longer hospitalization (defined as≥3 days) were identified by multivariate analysis. RESULTS Of 9,593 laparoscopic gastric bypass operations, median length of stay was 2 days (range 0-544) and 26% of patients required≥3 days of hospitalization. In multivariate analysis, longer hospitalization was predicted by diabetes, chronic obstructive pulmonary disease, bleeding diathesis, renal insufficiency, hypoalbuminemia, prolonged operating time, and resident involvement with the procedure, but not by patient age, sex, body mass index, and other co-morbidities. CONCLUSION Patient characteristics and operative details predict length of hospitalization after laparoscopic gastric bypass. Such data can be used to identify patients inappropriate for fast-track protocols.
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Affiliation(s)
- Jonathan Carter
- Department of Surgery, University of California-San Francisco, San Francisco, California.
| | - Steven Elliott
- Department of Surgery, University of California-San Francisco, San Francisco, California
| | - Jennifer Kaplan
- Department of Surgery, University of California-San Francisco, San Francisco, California
| | - Matthew Lin
- Department of Surgery, University of California-San Francisco, San Francisco, California
| | - Andrew Posselt
- Department of Surgery, University of California-San Francisco, San Francisco, California
| | - Stanley Rogers
- Department of Surgery, University of California-San Francisco, San Francisco, California
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Fast Track Care for Gastric Bypass Patients Decreases Length of Stay Without Increasing Complications in an UnselectedPatient Cohort. Obes Surg 2013; 24:390-6. [DOI: 10.1007/s11695-013-1133-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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