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Kleipool SC, Willinge GJA, Mathijssen EGE, Romijnders KAGJ, de Castro SMM, Marsman HA, van Rutte PWJ, van Veen RN. Patient Satisfaction and Experience with Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass: A Mixed-Methods study. Obes Surg 2024; 34:2862-2871. [PMID: 38795202 PMCID: PMC11289211 DOI: 10.1007/s11695-024-07264-8] [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: 12/21/2023] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/27/2024]
Abstract
INTRODUCTION Same-day discharge (SDD) after laparoscopic Roux-en-Y gastric bypass (RYGB) is a safe and effective healthcare pathway. However, there is limited understanding of the patient perspective on SDD. The aim of this study was to explore patient satisfaction and experience with SDD after RYGB. METHODS A mixed-methods study with a concurrent design was conducted in a Dutch teaching hospital, using questionnaires and interviews. Patients who underwent RYGB and were discharged on the day of the surgery completed four questionnaires of the BODY-Q (satisfaction with the surgeon, satisfaction with the medical team, satisfaction with the office staff, and satisfaction with information provision) ± 4 months postoperative. The results of the questionnaires were compared with pre-existing data from a cohort of patients who stayed overnight after surgery (i.e., control group). A subset of patients was individually interviewed for an in-depth understanding of the patient perspective on SDD. RESULTS In the questionnaires, median scores for the control group (n = 158) versus the present group of patients (n = 51) were as follows: 92/100 vs. 92/100 (p = 0.331) for the surgeon, 100/100 vs. 92/100 (p = 0.775) for the medical team, 100/100 vs. 100/100 (p = 0.616) for the office staff, and 90/100 vs. 73/100 (p = 0.015) for information provision. Interviews with 14 patients revealed seven themes, describing high satisfaction, along with several points of interest. CONCLUSIONS Patient satisfaction with SDD after RYGB is high, although information provision regarding the day of surgery could be improved. However, not every medically eligible patient might be suitable for this healthcare pathway, as responsibilities are shifted.
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Affiliation(s)
| | | | - Elke G E Mathijssen
- The Healthcare Innovation Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim A G J Romijnders
- The Healthcare Innovation Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Ruben N van Veen
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
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Bharani T, Tavakkoli A, Tsai TC, Robinson MK, Sheu EG. Safety of Same-Day Discharge after Bariatric Surgery: Retrospective 6-Year North American Analysis. J Am Coll Surg 2024; 238:1023-1034. [PMID: 38376072 DOI: 10.1097/xcs.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND With increasing implementation of Enhanced Recovery After Surgery protocols and rising demand for inpatient hospital beds accentuated by COVID-19, there has been interest in same-day discharge (SDD) for bariatric surgery. The aim of this study was to determine the national trends, safety profile, and risk factors for complications of SDD for minimally invasive bariatric surgery. STUDY DESIGN We analyzed the MBSAQIP database from 2016 to 2021 to characterize trends in SDD for minimally invasive bariatric operation. Multivariate logistic regression was performed on preoperative patient characteristics predictive of increased complications associated with SDD. A comparative analysis of postoperative outcomes within 30 days was performed for SDD and admission after 1:1 nearest neighbor propensity score matching for patient demographics and preoperative comorbidities. RESULTS SDD increased from 2.4% in 2016 to 7.4% in 2021. Major preoperative factors associated with increased complications for SDD included Black race, history of MI, renal insufficiency, deep vein thrombosis, and smoking. SDD for Roux-en-Y gastric bypass had 72% increased risk of postoperative complications compared with sleeve gastrectomy. The overall major complications were lower in SDD cohort vs admission cohort (odds ratio [OR] 0.62, p < 0.01). However, there was a significant increase in deaths within 30 days (OR 2.11, p = 0.01), cardiac arrest (OR 2.73; p < 0.01), and dehydration requiring treatment (OR 1.33; p < 0.01) in SDD cohort compared with admission cohort. CONCLUSIONS Nationally, there has been a rise in SDD for bariatric operation from 2016 to 2021. Matched analysis demonstrates that SDD is associated with a significantly higher mortality rate. Additionally, the risk of complications with SDD is higher for RYGB compared with sleeve gastrectomy. Therefore, further studies are required to appropriately select patients for whom bariatric surgery can be safely performed as an outpatient.
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Affiliation(s)
- Tina Bharani
- From the Department of Surgery, Brigham and Women's Hospital, Boston, MA
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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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Landreneau JP, Agarwal D, Witkowski E, Meireles O, Flanders K, Hutter M, Gee D. Safety and cost of performing laparoscopic sleeve gastrectomy with same day discharge at a large academic hospital. Surg Endosc 2024; 38:2212-2218. [PMID: 38379004 DOI: 10.1007/s00464-024-10673-6] [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: 06/12/2023] [Accepted: 12/30/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most common surgical treatment for morbid obesity. While certain specialized ambulatory surgery centers offer LSG on an outpatient basis, patients undergoing LSG at most academic centers are admitted to hospital for initial postoperative convalescence and monitoring. Our institution has begun to offer LSG with same-day discharge (SDD) in select patients. We aimed to compare the perioperative outcomes and costs for patients undergoing LSG with inpatient admission versus SDD. METHODS All patients enrolled in the SDD program from December 2020 through July 2022 were identified from a prospectively maintained database. Patients enrolled in this pathway were analyzed on an intention-to-treat basis even if ultimately admitted postoperatively. Propensity scoring was used to match these patients 1:1 to those with planned inpatient recovery based on age, BMI, and ASA classification. RESULTS Seventy-five patients were enrolled in the LSG with SDD program during the study period. Among these, 62 patients (82.7%) had successful immediate postoperative discharge. Reasons for cancelation of planned SDD included anxiety (n = 5), pain (n = 3), nausea (n = 2), and one patient each with hypotension, urinary retention, and bleeding. After matching, there were no differences in age, BMI, or ASA classification in a comparison group of patients with planned inpatient recovery. There were no differences in perioperative complications. There were no readmissions or requirements for outpatient intravenous fluids among patients with SDD, compared to n = 3 (4.0%) and n = 2 (2.7%) in the inpatient cohort, respectively. The total perioperative cost for patients undergoing LSG with planned SDD was 6.8% less than those with inpatient recovery. CONCLUSION With appropriate protocols, LSG with same-day discharge can safely be performed at large academic surgery centers without increased morbidity or need for additional services in the perioperative period. SDD may be associated with decreased costs and allows for more efficient hospital bed allocation.
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Affiliation(s)
- Joshua P Landreneau
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Divyansh Agarwal
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Elan Witkowski
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Ozanan Meireles
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Karen Flanders
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Matthew Hutter
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Denise Gee
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Triantafyllou E, Scholer V, Calabrese D, Ribeiro-Parenti L, Msika S, Rebibo L. Is Routine Post-operative Biological Laboratory Assessment Necessary After Sleeve Gastrectomy? Obes Surg 2024; 34:707-715. [PMID: 38273145 DOI: 10.1007/s11695-024-07065-z] [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: 05/17/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Incidence of post-operative complications after sleeve gastrectomy (SG) is low. However, the early identification of these complications remains crucial. Here, we report the impact of routine laboratory monitoring for the early diagnosis of complications after SG. MATERIAL AND METHODS From January 2018 to December 2019, all consecutive patients who underwent primary SG (n = 457) were included. This was a comparative study of patients undergoing primary SG. Patients were divided into two groups: one group with routine laboratory monitoring performed at postoperative day (POD) 1 and 3 (LAB group) and another group without routine laboratory monitoring (control group). The study's primary endpoint was the overall impact of routine laboratory monitoring. The secondary endpoints were evaluation of patients with complications. RESULTS The population in the two groups were similar in term of demographic and intra-operative data. There was a statistical difference between the two groups in term of length of stay (5.7 days in the LAB group and 3.5 days in the control group (p < 0.001)). There were 19 complications (6.0%) in the LAB group and 5 complications in the control group (3.5%) (p = 0.25). A cut-off C-reactive protein level of 46.3 mg/l was found to be significant (p = 0.006). In the LAB group, 9 patients (2.9%) required readmission vs. three patients (2.0%) in the control group (p = 0.62). CONCLUSION The interest of routine laboratory monitoring after SG seems limited. Routine laboratory monitoring alone is not associated with earlier diagnosis of complications. This routine monitoring is associated with an increase of stay in hospital.
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Affiliation(s)
- Evangelia Triantafyllou
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
| | - Vincent Scholer
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
- Service de Chirurgie, GHI Le Raincy-Montfermeil, 93370, Montfermeil, France
| | - Daniela Calabrese
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
- Université de Paris, Inserm UMR 1149, 75018, Paris, France
| | - Lara Ribeiro-Parenti
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
- Université de Paris, Inserm UMR 1149, 75018, Paris, France
| | - Simon Msika
- Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France
- Université de Paris, Inserm UMR 1149, 75018, Paris, France
| | - Lionel Rebibo
- Université de Paris, Inserm UMR 1149, 75018, Paris, France.
- Service de Chirurgie Digestive Et Oncologique, Hôpital Européen Georges Pompidou, APHP, 75015, Paris, France.
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Kleipool SC, van Rutte PWJ, Vogel M, Bonjer HJ, de Castro SMM, van Veen RN. Feasibility of same-day discharge after laparoscopic sleeve gastrectomy in the Netherlands. Surg Endosc 2024; 38:872-879. [PMID: 38082016 DOI: 10.1007/s00464-023-10590-0] [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: 09/20/2023] [Accepted: 11/11/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND There is a trend towards laparoscopic sleeve gastrectomy (SG) with same-day discharge (SDD), as an efficient healthcare pathway to alleviate the burden on clinical capacity. This approach seems to be safe, if patients are carefully selected. In our bariatric center, a protocol for Roux-en-Y gastric bypass with SDD has already been successfully implemented. The aim of this study was to evaluate feasibility of applying the same SDD protocol for SG. METHODS A single-center prospective feasibility study was conducted at a high-volume bariatric center. Low-risk patients who were scheduled for primary SG were included. Strict criteria were used for approval upon SDD. The primary outcome was the rate of successful SDD without readmission within 48 h. Secondary outcomes included short-term complications, emergency department visits, readmissions, and mortality. RESULTS Fifty patients were included in the study, of whom 45 were successfully discharged on the same day of the surgery. Nausea and vomiting were the most common reasons for overnight hospitalization (three patients). One patient was readmitted within the first 48 h due to a mild complication related to bleeding, resulting in a success rate of 88% for SDD without readmission within 48 h. No severe complications or mortality were reported in the cohort. CONCLUSION Our SDD protocol for SG has demonstrated feasibility, with a high success rate of SDD and no severe complications. Strict conditions should be met for the safe implementation of a SDD protocol, including careful patient selection and the establishment of a safety net to detect early complications.
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Affiliation(s)
- Suzanne C Kleipool
- Department of Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - Pim W J van Rutte
- Department of Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Marlou Vogel
- Department of Anesthesiology, OLVG Hospital, Amsterdam, The Netherlands
| | - H Jaap Bonjer
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Steve M M de Castro
- Department of Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Ruben N van Veen
- Department of Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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Alshahrani MS, Babiker AM, Alsuhaibani YA. Laparoscopic sleeve gastrectomy as a hybrid day care procedure: a case series of the first 53 patients at a tertiary care center. Updates Surg 2023; 75:2127-2132. [PMID: 37543955 PMCID: PMC10710377 DOI: 10.1007/s13304-023-01591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/08/2023] [Indexed: 08/08/2023]
Abstract
Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure. Outpatient LSG is gaining popularity, but the literature is conflicting regarding its safety. Innovative approaches are needed to improve access to bariatric surgery. In this pilot study, we proposed an alternative approach to assess the safety and efficacy of LSG in selected cases as hybrid day care surgery. Data were collected retrospectively from 53 patients who underwent LSG between June 2017 and September 2020 using a hybrid day care approach. Outcomes of the study included patient demographics, clinical characteristics, and outcome variables, including conversion to inpatient care, emergency room visits after discharge, and patient satisfaction. Fifty-three patients (68% females) were included in the study. Mean age was 35.32 years, and mean preoperative body mass index was 42.93. The most common comorbidity was type 2 diabetes mellitus (30.2%), followed by hypertension (15.09%), hypothyroidism (13.2%), and dyslipidemia (9.4%). One (1.89%) patient visited the emergency room because of abdominal pain and was managed and discharged with analgesia. Readmission within 24 h of discharge was not required. One (1.89%) patient developed a staple line gastric leak two weeks after the surgery and was successfully managed with a gastric stent. The series had no mortality, with high patient and family satisfaction. Our approach to performing LSG in hybrid day care surgery is safe and feasible. Adopting this protocol will improve the utilization of resources, while maintaining high levels of patient satisfaction with safety outcomes comparable to the current practice.
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Affiliation(s)
- Mohammad S Alshahrani
- Surgical Oncology Department, Consultant Hepatobiliary and Upper GI Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ayman M Babiker
- Surgical Oncology Department, Consultant General Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Youssuf A Alsuhaibani
- Surgical Oncology Department, Consultant Colorectal and Bariatric Surgery, King Fahad Medical City, Riyadh, Saudi Arabia.
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Schaffner TJ, Wilkes M, Laverty R, Schwab SD, Zahradka N, Pugmire J, Yourk D, Masella PC, Walter R. Remote patient monitoring to facilitate same-day discharge after laparoscopic sleeve gastrectomy: a pilot evaluation. Surg Obes Relat Dis 2023; 19:1067-1074. [PMID: 37105773 PMCID: PMC10015823 DOI: 10.1016/j.soard.2023.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/10/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Limited hospital inpatient capacity, exacerbated by SARS-CoV-2 (COVID-19) and associated staffing shortages, has driven interest in converting surgeries historically done as inpatient procedures to same-day surgeries (SDS). Remote patient monitoring (RPM) has the potential to increase safety and confidence in SDS but has had mixed success in a bariatric population. OBJECTIVES Assess the feasibility of and adherence to a protocol offering patients same-day laparoscopic sleeve gastrectomy (SG) supported by RPM with an updated wearable device. Secondary outcomes were readmissions, costs, adherence, and clinical alarm rates. SETTING Academic, military tertiary referral center (United States). METHODS A single-center, retrospective case control study of patients undergoing SG, comparing SDS with RPM to patients admitted to the hospital for SG during this time. Patients for SDS were selected by set inclusion/exclusion criteria and patient/surgeon preference, and perioperative management was standardized. RESULTS Twenty patients were enrolled in the SDS group, then compared with 53 inpatients. Inpatients were older (46 versus 39, P = .006), but with no significant differences in sex, preoperative body mass index, or co-morbidities. RPM wearable and blood pressure adherence was found to be 97% and 80%, respectively. Readmission rates were similar (10% versus 7.5%, P > .05). RPM alarm rates were .5 (0-1.3) per patient for each 24-hour home monitoring period. SDS patients also demonstrated the potential for cost savings over inpatient SG, depending on the number of patients monitored per day as well as the healthcare setting. CONCLUSIONS SG as SDS with RPM was a feasible approach. It should be evaluated in other surgical procedures and higher-risk patient populations.
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Affiliation(s)
- Timothy J Schaffner
- Department of Surgery, Brooke Army Medical Center, San Antonio, Texas; Bon Secours Surgical Specialists, Bon Secours Mercy Health, Portsmouth, Virginia.
| | | | - Robert Laverty
- Department of Surgery, Brooke Army Medical Center, San Antonio, Texas
| | - Stephen D Schwab
- Department of Surgery, Brooke Army Medical Center, San Antonio, Texas; Hankamer School of Business, Baylor University, Waco, Texas
| | | | | | - Dan Yourk
- Current Health Inc., Boston, Massachusetts
| | - Pamela C Masella
- Department of Surgery, Brooke Army Medical Center, San Antonio, Texas
| | - Robert Walter
- Department of Surgery, Brooke Army Medical Center, San Antonio, Texas
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Vanetta C, Dreifuss NH, Angeramo CA, Baz C, Cubisino A, Schlottmann F, Masrur MA. Outcomes of same-day discharge sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:238-249. [PMID: 36209031 DOI: 10.1016/j.soard.2022.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022]
Abstract
Length of stay after bariatric surgery has progressively shortened. Same-day discharge (SDD) has been reported for the 2 most common bariatric procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of this study is to evaluate the safety and success of SDD following SG and RYGB. Systematic literature search on SDD after bariatric surgery was conducted in Medline, Cochrane library, Google Scholar, and Embase. SDD was defined as discharging the patient during the day of the bariatric operation, without an overnight stay. The primary outcomes of interest were successful SDD, readmission, and morbidity rates. The secondary endpoints included reoperation and mortality rates. A proportion meta-analysis was performed to assess the outcomes of interest. A total of 14 studies with 33,403 patients who underwent SDD SG (32,165) or RYGB (1238) were included in the qualitative synthesis. Seven studies with 5000 patients who underwent SDD SG were included in the quantitative analysis, and pooled proportions (PPs) were calculated for the outcomes of interest. The SDD success rate was 63%-100% (PP: 99%) after SG and 88%-98.1% after RYGB. The readmission rate ranged from .6% to 20.8% (PP: 4%) after SDD SG and 2.4%-4% after SDD RYGB. Overall morbidity, reoperation, and mortality were 1.1%-10% (PP:4%), .3%-2.1% (PP: 1%), and 0%-.1% (PP: 0%), respectively, for SDD SG, and 2.5%-4%,1.9%-2.5%, and 0%-.9%, respectively, for SDD RYGB. SDD after SG seems feasible and safe. The outcomes of SDDRYGB seem promising, but the evidenceis stilllimitedto draw definitive conclusions. Selection criteria and perioperative protocolsmust be standardized to adequately introduce this practice.
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Affiliation(s)
- Carolina Vanetta
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.
| | - Nicolás H Dreifuss
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | | | - Carolina Baz
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Antonio Cubisino
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Francisco Schlottmann
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Mario A Masrur
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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Bariatric surgeon perceptions of the safety of same-day sleeve gastrectomy in the state of Massachusetts. Surg Obes Relat Dis 2022; 19:451-457. [PMID: 36702648 DOI: 10.1016/j.soard.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/17/2022] [Accepted: 10/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND During the past 2.5 years, select bariatric surgeons in the Commonwealth of Massachusetts have been implementing same-day sleeve gastrectomy (SDSG). Key reasons for this change have been to reduce risks associated with hospitalization in the context of the COVID-19 pandemic and to comply with third-party payer preference to reduce costs. OBJECTIVE We aimed to evaluate bariatric surgeons' attitudes about outcomes and morbidity between patients who are hospitalized after sleeve gastrectomy and patients who undergo SDSG. SETTING Beth Israel Deaconess Medical Center in Boston, Massachusetts (teaching hospital of Harvard Medical School). METHODS This prospective cohort study was conducted among bariatric surgeons practicing in the Commonwealth of Massachusetts. An anonymous web-based questionnaire was distributed using the Research Electronic Data Capture software. A total of 58 bariatric surgeons in Massachusetts were identified and successfully contacted based on registration with the Massachusetts Board of Registration in Medicine, membership in the American Society for Metabolic and Bariatric Surgery, and internet search. RESULTS A total of 33 bariatric surgeons in Massachusetts completed the survey, yielding a response rate of 56.9%. Among the respondents, 75.76% have not performed SDSG, reporting patient safety as the major concern, and 24.24% had performed SDSG in the past. CONCLUSION Survey responses showed no significant differences in surgeon perception between SDSG and hospitalization after surgery. Optimal patient selection was an important factor influencing surgeons' decisions with regard to performing SDSG. However, bariatric surgeons in Massachusetts are reluctant to perform SDSG.
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Is Same-Day Discharge After Roux-en-Y Gastric Bypass Safe? A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database Analysis. Obes Surg 2022; 32:3900-3907. [PMID: 36194348 PMCID: PMC9531221 DOI: 10.1007/s11695-022-06303-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
Purpose
Same-day discharge (SDD) after bariatric surgery is gaining popularity. We aimed to analyze the safety of SDD after Roux-en-Y gastric bypass (RYGB) and compare its outcomes to inpatients discharged on postoperative days 1–2. Materials and Methods We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the period 2015–2020. Patients who underwent primary laparoscopic RYGB and were discharged the same day of the operation (SDD-RYGB) and inpatients discharged on postoperative days 1–2 (In-RYGB) were compared. Primary outcomes of interest were overall morbidity, serious morbidity, readmission, reoperation, intervention, and mortality rates. Results A total of 167,188 patients were included; 2156 (1.3%) SDD-RYGB and 165,032 (98.7%) In-RYGB. Mean age (SDD-RYGB: 44.5 vs. In-RYGB: 44.6 years), proportion of females (SDD-RYGB: 81.4% vs. In-RYGB: 80.6%), and mean body mass index (SDD-RYGB: 45.8 vs. In-RYGB: 45.9 kg/m2) were similar between groups. Overall morbidity (SDD-RYGB: 11.3% vs. In-RYGB: 10.2%; OR: 1.2, p = 0.08), serious morbidity (SDD-RYGB: 3.1% vs. In-RYGB: 3%; OR: 1.03, p = 0.81), reoperation (SDD-RYGB: 1.4% vs. In-RYGB: 1.2%; OR: 1.16, p = 0.42), readmission (SDD-RYGB: 4.8% vs. In-RYGB: 4.8%; OR: 1.01, p = 0.89), and mortality (SDD-RYGB: 0.04% vs. In-RYGB: 0.09%; OR: 0.53, p = 0.53) were comparable between groups. SDD-RYGB had lower risk of 30-day interventions (SDD-RYGB: 1.1% vs. In-RYGB: 1.6%; OR: 0.64, p = 0.04) compared to In-RYGB. Conclusion Same-day discharge after RYGB seems to be safe and has comparable outcomes to admitted patients. Standardized patient selection criteria and perioperative management protocols are needed to further increase the safety of this practice. Graphical abstract ![]()
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Mascitti P, Beaussier M, Sciard D, Boutron MC, Ghedira A, Pourcher G. Immediate postoperative pain does not predict pain at home after ambulatory single-port sleeve gastrectomy. Langenbecks Arch Surg 2022; 407:2739-2746. [PMID: 35708775 DOI: 10.1007/s00423-022-02560-2] [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: 10/19/2021] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Single-port sleeve gastrectomy (SPSG) is increasingly performed in an ambulatory setting. Pain intensity when returning home remains a problem. The challenge is to be able to predict the evolution of postoperative pain (POP) at home by using parameters collected during the hospital stay. This study aimed to investigate whether immediate POP in the postanesthesia care unit (PACU) can predict pain intensity 24 h after surgery. METHODS Single-center retrospective study in patients with obesity who underwent ambulatory SPSG. POP and opiate requirements during PACU stay were registered. Patients were followed up at home during the first 4 postoperative days. The primary outcome was the correlation between opiate requirements in the PACU and Numerical Rating Scale (NRS) at home 24 h after surgery. Secondly, logistic regression was used to identify risk factors for moderate/intense pain 24 h after surgery. RESULTS Ninety-four patients were included during the study period. Twenty-two patients had NRS > 3/10 24 h after surgery. No correlation was found between the total dose of morphine in the PACU and pain intensity 24 h after surgery (r2 = - 0.07; P = 0.49). No predictive factor for moderate/intense pain 24 h after surgery was found. CONCLUSION No correlation was found between opiate requirements in the PACU and pain at home 24 h after SPSG. Based on these results, it does not seem possible to predict intense pain at home from pain profile and morphine requirement during the immediate postoperative period.
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Affiliation(s)
- Paola Mascitti
- Department of Anesthesia, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
- Unit of Bariatric Surgery and the Ambulatory Surgery Unit, Institut Mutualiste Montsouris, Paris, France
| | - Marc Beaussier
- Department of Anesthesia, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France.
- Unit of Bariatric Surgery and the Ambulatory Surgery Unit, Institut Mutualiste Montsouris, Paris, France.
| | - Didier Sciard
- Department of Anesthesia, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
- Unit of Bariatric Surgery and the Ambulatory Surgery Unit, Institut Mutualiste Montsouris, Paris, France
| | - Marie-Christine Boutron
- Obesity Center, Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France
- Centre de Recherche en Epidémiologie Et Santé Des Population (CESP), INSERM, Paris-Saclay University, Paris, France
| | - Abdessalem Ghedira
- Obesity Center, Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Guillaume Pourcher
- Unit of Bariatric Surgery and the Ambulatory Surgery Unit, Institut Mutualiste Montsouris, Paris, France
- Obesity Center, Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France
- Centre de Recherche en Epidémiologie Et Santé Des Population (CESP), INSERM, Paris-Saclay University, Paris, France
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A Cost Analysis of Healthcare Episodes Including Day-Case Bariatric Surgery (Roux-en-Y Gastric Bypass and Sleeve Gastrectomy) Versus Inpatient Surgery. Obes Surg 2022; 32:2504-2511. [PMID: 35689142 DOI: 10.1007/s11695-022-06144-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Assessing the medico-economic outcomes of a healthcare pathway including day-case bariatric surgery versus the conventional pathway. METHODS This economical evaluation is a prospective cohort study with historical controls. Between March 2019 and December 2020, 30 patients eligible for bariatric surgery were considered in the day-case group. Surgical procedures included sleeve gastrectomy and Roux-en-Y gastric bypass. The day-case pathway included patient education, post-discharge follow-up by a community nurse twice-daily and standardized communications to surgeons. Day-case patients were paired with 30 inpatients, based on the type of intervention, age, and ASA status. The primary outcome was the cost of care episodes from the preoperative visit to the 30-day postoperative visit. Micro-costing methodology and activity-based costing were used. Secondary outcomes included length of hospital stay, rate of unanticipated events, and patient' satisfaction assessment. RESULTS Male-to-female ratio was 1/2. In the day-case versus inpatient group, age, number of associated medical conditions, and BMI (42.9 ± 4.9 versus 42.6 ± 4.6, p > 0.05) were similar. In the day-case group, there were 7 overnight stays (23.3%), 3 readmissions (10%), and 4 unscheduled consultations (13.3%). The overall length of hospital stay was significantly shorter (0.65 ± 0.33, versus 2.9 ± 0.4 days, p < 0.0001). The complication rate was 6.6% in both groups. The cost of the care episode was € 4272.9 ± 589.7 for the day-case group versus € 4993.7 ± 695.6 for inpatients, corresponding to a 14.4% cost reduction (p = 0.0254). CONCLUSIONS Day-case bariatric surgery appears to be safe and beneficial in terms of costs. It involves a specific organization with postdischarge follow-up. TRIAL REGISTRATION ClinicalTrial.gov: NCT04423575.
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Alqahtani AR, Elahmedi M, Amro N, Abdurabu HY, Abdo N, Alqahtani S, Boutros A, Ebishi A, Al-Darwish A. Laparoscopic Sleeve Gastrectomy as Day Case Surgery vs Conventional Hospitalization: Results of the DAYSLEEVE Randomized Clinical Trial. Surg Obes Relat Dis 2022; 18:1141-1149. [DOI: 10.1016/j.soard.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
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Verhoeff K, Mocanu V, Dang J, Wilson H, Switzer NJ, Birch DW, Karmali S. Impact of the COVID-19 pandemic on bariatric surgery in North America – A retrospective analysis of 834,647 patients. Surg Obes Relat Dis 2022; 18:803-811. [PMID: 35474010 PMCID: PMC8933967 DOI: 10.1016/j.soard.2022.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 12/27/2022]
Abstract
Background COVID-19 has transformed surgical care, yet little is known regarding implications for bariatric surgery. Objective We sought to characterize the effect of COVID-19 on bariatric surgery delivery and outcomes. Setting The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) collects data from 885 centers in North America. Methods The MBSAQIP database was evaluated with 2 cohorts described: the COVID-19 and the pre–COVID-19, with patients receiving surgery in 2020 and 2015–2019, respectively. Yearly operative trends were characterized, and bivariate analysis compared demographics and postoperative outcomes. Multivariable modeling evaluated 30-day readmission, reintervention, and reoperation rates and factors associated with undergoing Roux-en-Y gastric bypass. Results We evaluated 834,647 patients, with 155,830 undergoing bariatric surgery during the 2020 pandemic year. A 12.1% reduction in total cases (177,208 in 2019 versus 155,830 in 2020; P < .001) and 13.8% reduction in cases per center occurred (204.2 cases per center in 2019 versus 176.1 cases per center in 2020; P < .001). Patients receiving bariatric surgery during the pandemic were younger and had fewer co-morbidities. Use of sleeve gastrectomy increased (74.5% versus 72.5%; P < .001), and surgery during COVID-19 was associated with reduced Roux-en-Y gastric bypass procedure selection (odds ratio = .83; 95% CI: .82–.84; P < .001). Length of stay decreased significantly (1.4 ± 1.4 days versus 1.6 ± 1.4 days; P < .001), yet postoperative outcomes were similar. After adjusting for co-morbidities, patients during COVID-19 had decreased 30-day odds of readmission and reintervention and a small increase in odds of reoperation. Conclusion The COVID-19 pandemic dramatically changed bariatric surgery delivery. Further studies evaluating the long-term effects of these changes are warranted.
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Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jerry Dang
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hillary Wilson
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel W Birch
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Dreifuss NH, Xie J, Schlottmann F, Cubisino A, Baz C, Vanetta C, Mangano A, Bianco FM, Gangemi A, Masrur MA. Risk Factors for Readmission After Same-Day Discharge Sleeve Gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database Analysis. Obes Surg 2022; 32:962-969. [PMID: 35060023 PMCID: PMC8773397 DOI: 10.1007/s11695-022-05919-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
Background Same-day discharge after sleeve gastrectomy (SG) is gaining popularity. We aimed to determine risk factors associated with readmission in patients who underwent same-day discharge SG. Methods We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for the period 2015–2018. Patients who underwent SG and were discharged the same day of the operation were included in the analysis. Multivariable logistic regression analysis was performed to determine risk factors for readmission. Results A total of 466,270 SG were performed during the study period; 14,624 (3.1%) patients were discharged the same day and were included in the analysis. Mean age was 43.4 (14.7–80) years and 11,718 (80.1%) were female. Mean preoperative BMI was 43.7 ± 7.4 kg/m2. Mean operative time was 58.3 ± 32.4 min. Thirty-day reoperation, reintervention, and mortality rates were 0.7%, 0.7%, and 0.1%, respectively. Readmission rates were similar in same-day discharge and inpatient SG (2.9% vs. 3%, p = 0.5). Female sex (OR 1.52, 95% CI 1.15–2.00), preoperative gastroesophageal reflux disease (OR 1.33, 95% CI 1.08–1.64), renal insufficiency (OR 3.06, 95% CI 1.01–9.32), and intraoperative drain placement (OR 1.78, 95% CI 1.37–2.31) were independent risk factors for readmission following same-day discharge SG. Conclusions
Same-day discharge SG appears to be safe and is associated with low readmission rates. However, the identification of preoperative and intraoperative variables associated with higher risk of readmission might help defining safer and more effective same-day discharge protocols. Graphical abstract ![]()
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Affiliation(s)
- Nicolas H Dreifuss
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA.
| | - Julia Xie
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA
| | - Francisco Schlottmann
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA
| | - Antonio Cubisino
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA
| | - Carolina Baz
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA
| | - Carolina Vanetta
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA
| | - Alberto Mangano
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA
| | - Francesco M Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA
| | - Antonio Gangemi
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA
| | - Mario A Masrur
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, Clinical Sciences Building, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Chicago, IL, 60612, USA
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Newbold R, Craven A, Aly A. Efficacy of patient selection criteria for obesity surgery in a non-high-dependency unit/intensive care unit facility. ANZ J Surg 2021; 91:1528-1533. [PMID: 34031972 DOI: 10.1111/ans.16960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUNDS Publicly funded obesity surgery remains underfunded in Australia. One barrier to expansion is the perception that perioperative care requires critical care facilities. This study evaluates the effectiveness of patient selection criteria in avoiding unplanned patient transfer and adverse outcomes in obesity surgery performed at a facility without a high-dependency unit/intensive care unit (HDU/ICU). METHODS Retrospective analysis was performed on patients undergoing obesity surgery between January 2017 and March 2020 in a centre with specific screening criteria. Criteria included: body mass index <48 for males and <52 for females with up to three stable comorbidities from a selected list. Revision sleeve or bypass procedures were contraindicated. Primary outcome was patient transfer to our main campus. Secondary outcomes included return to theatre (RTT), readmission and death. Outcomes were compared to laparoscopic cholecystectomies (LC) performed at the same centre. RESULTS A total of 387 obesity surgery procedures were performed; 372 patients (96%) were discharged without complication. Fifteen (3.9%) were transferred to the main campus, eight were admitted to ICU and two required re-operation. Twelve (3.1%) were readmitted within 30 days of discharge, five required re-operation. Transfer, 30-day readmission and 30-day emergency department presentation rates were similar in comparison to LC. RTT during index admission (0.5% vs. 3.0%; p = 0.006) and during 30-day post-operative period (1.8% vs. 4.4%; p = 0.025) was lower in the obesity surgery group. CONCLUSION Carefully selected screening criteria allow obesity surgery to be performed at a well-supported non-HDU/ICU facility with few complications and acceptable rates of unplanned patient transfer.
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Affiliation(s)
- Ryan Newbold
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Alexander Craven
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Ahmad Aly
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
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Aryaie AH, Reddy V, Dattilo Z, Janik MR. Safety of same-day discharge after laparoscopic sleeve gastrectomy: propensity score-matched analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Registry. Surg Obes Relat Dis 2020; 17:46-53. [PMID: 33268322 DOI: 10.1016/j.soard.2020.08.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/30/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Information on the safety of outpatient sleeve gastrectomy is sparse. OBJECTIVE This study aimed to assess the safety of sleeve gastrectomy as a day case surgery. SETTING University health network, United States. METHODS Patients who underwent primary sleeve gastrectomy were identified in the 2015-2017 MBSAQIP database. Day case surgery procedure was defined as having a hospital length of stay of 0 days. Day case surgery patients were matched with inpatient controls using propensity score matching. The primary outcome was 30-day mortality. RESULTS A total of 271,658 sleeve gastrectomy patients met the inclusion criteria. Of these, only 7825 (2.88 %) were day case surgery procedures. There was no mortality in the group. Day case surgery, compared with inpatient sleeve gastrectomy, was associated with a similar risk of a leak (.56% versus .40%; relative risk [RR], 1.419; 95% CI, .896-2.245; P = .133), bleeding (.38% versus .31%; RR, 1.250; 95% CI, .731-2.138; P = .414), 30-day reoperation (.81% versus .56%; RR, 1.432; 95% CI, .975-2.104; P = .066), and 30-day morbidity (1.15% versus 1.01%; RR, 1.139; 95% CI, .842-1.541; P = .397). Outpatients' SG increased the risk for 30-day readmission (3.35% versus 2.79%; RR, 1.202; 95% CI, 1.009-1.432; P = .039). CONCLUSIONS Sleeve gastrectomy in the outpatient setting as a day case surgery was associated with no mortality and no statistically significant risk of reoperation, leakage, or bleeding compared with patients admitted to inpatient units. The readmission rate was higher in the day case surgery group.
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Affiliation(s)
- Amir H Aryaie
- Department of Surgery, Bariatric Center of Excellence, Texas Tech University Health Science Center, Lubbock, Texas; Bariatric and Reflux Center, Georgia SurgiCare, Atlanta, Georgia
| | - Vamsi Reddy
- Medical College of Georgia, Augusta, Georgia
| | | | - Michał R Janik
- Department of Surgery, Bariatric Center of Excellence, Texas Tech University Health Science Center, Lubbock, Texas; Department of General, Oncologic, Metabolic, and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland.
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Fortin SP, Kalsekar I, Johnston S, Akincigil A. Comparison of safety and utilization outcomes in inpatient versus outpatient laparoscopic sleeve gastrectomy: a retrospective, cohort study. Surg Obes Relat Dis 2020; 16:1661-1671. [PMID: 32811709 DOI: 10.1016/j.soard.2020.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/14/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most common type of bariatric surgery performed in the United States and may be performed on an outpatient basis. Limited literature exists comparing outcomes of outpatient and inpatient LSG, and study results are conflicting. OBJECTIVES To compare safety and utilization outcomes of outpatient versus inpatient LSG. SETTINGS Retrospective, multihospital database study (Optum Pan-Therapeutics Database). METHODS Patients 18 years of age and older who underwent LSG between October 1, 2015, and December 31, 2018, were identified from the Optum Pan-Therapeutics Database and classified as having undergone outpatient or inpatient surgery. Nearest neighbor propensity score matching and generalized estimating equations accounting for procedural physician-level clustering were used to compare the following outcomes between outpatient and inpatient LSG: all-cause 30-day patient morbidity, hospital readmission, readmission length of stay, bariatric reoperation. and mortality. RESULTS We identified 22,945 patients (outpatient: 1542; inpatient: 21,403) meeting the study inclusion criteria. After propensity score matching, the inpatient and outpatient groups contained 1542 and 13,903 patients, respectively. Bariatric reoperation (n = 13) and mortality (n = 5) were rare events occurring in <.1% of all cases. Compared with the inpatient group, the outpatient group had a statistically significant lower readmission length of stay (4.63 versus 3.23 days; P = .0057). Otherwise, there was no significant association between procedure setting and 30-day overall morbidity (4.8% versus 5.3%; P = .5775) or hospital readmission (2.6% versus 2.1%; P = .1841). CONCLUSIONS Safety and utilization outcomes were similar between outpatient and inpatient LSG, and outpatient LSG was associated with shorter hospital readmission length of stay.
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Affiliation(s)
- Stephen P Fortin
- Observational Health Data Analytics, Epidemiology, Raritan, New Jersey.
| | - Iftekhar Kalsekar
- Observational Health Data Analytics, Epidemiology, Raritan, New Jersey
| | - Stephen Johnston
- Medical Devices, Epidemiology, Johnson & Johnson, New Brunswick, New Jersey
| | - Ayse Akincigil
- Health Outcomes, Policy, and Economics, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
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Barbat S, Thompson KJ, Mckillop IH, Kuwada TS, Gersin K, Nimeri A. Ambulatory bariatric surgery: does it really lead to higher rates of adverse events? Surg Obes Relat Dis 2020; 16:1713-1720. [PMID: 32830058 DOI: 10.1016/j.soard.2020.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Correlating patient outcomes with length of stay (LoS) is an important consideration in metabolic and bariatric surgery. At present, conflicting data exists regarding patient safety for ambulatory (AMB) metabolic and bariatric surgery. OBJECTIVE Outcomes for AMB-metabolic and bariatric surgery patients (LoS <1 d) undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were compared with matched patients with LoS ≥1 day (non-AMB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry. SETTING MBSAQIP national database. METHODS The MBSAQIP registry was queried for patients undergoing SG or RYGB (2015-2017) and patients grouped as AMB/non-AMB. Exclusion criteria included LoS >4 days, age <18 or >75 years, revision surgery, gastric banding, body mass index <35 kg/m2, and day of surgery mortality. Variables were combined into major/minor complications and 30-day mortality. Analysis was performed using univariate and multivariate logistic regression and propensity matching. RESULTS After exclusions were applied 408,895 patients remained (9973 AMB). Overall, 111,279 patients underwent RYGB (1032 AMB) and 297,616 underwent SG (8941 AMB), with similar demographic characteristics and co-morbidities between groups. For AMB patients, there was no increase in 30-day mortality, reoperation, or readmission, and fewer drains were placed versus matched non-AMB patients. In AMB-SG patients more surgical site infections were reported versus non-AMB-SG, although AMB-SG patients had fewer intensive care unit admissions. For AMB-RYGB, no differences in complications were detected versus non-AMB-RYGB. CONCLUSION Based on our analysis of the MBSAQIP database, patients undergoing laparoscopic RYGB or SG procedures can be safely discharged on the day of their procedure without increased incidence of mortality, reoperation, or readmission.
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Affiliation(s)
- Selwan Barbat
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
| | - Kyle J Thompson
- Surgical Research, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Iain H Mckillop
- Surgical Research, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Timothy S Kuwada
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Keith Gersin
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Abdelrahman Nimeri
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
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How can I manage anaesthesia in obese patients? Anaesth Crit Care Pain Med 2020; 39:229-238. [DOI: 10.1016/j.accpm.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 12/01/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022]
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Tabone LE. Comment on: Laparoscopic sleeve gastrectomy as day-case surgery: a case-matched study. Surg Obes Relat Dis 2019; 15:e15-e16. [PMID: 31085037 DOI: 10.1016/j.soard.2019.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Lawrence E Tabone
- Director of Metabolic and Weight Loss Surgery, Department of Surgery, West Virginia University, Morgantown, West Virginia
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