Top

Published in:

01-08-2016 | New Concept

Fast-Track in Bariatric and Metabolic Surgery: Feasibility and Cost Analysis Through a Matched-Cohort Study in a Single Centre

Authors: Vincenzo Simonelli, Martine Goergen, Gennaro G. Orlando, Luca Arru, Charalampos A. Zolotas, Maxim Geeroms, Virginie Poulain, Juan S. Azagra

Published in: Obesity Surgery | Issue 8/2016

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.

Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, Peña-Rosas JP, Bhutta ZA, Ezzati M, Nutrition Impact Model Study Group (Anaemia). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1(1):e16–25. doi:10.1016/S2214-109X(13)70001-9.CrossRefPubMedPubMedCentral

Stevens GA, Singh GM, Lu Y, Danaei G, Lin JK, Finucane MM, Bahalim AN, McIntire RK, Gutierrez HR, Cowan M, Paciorek CJ, Farzadfar F, Riley L, Ezzati M, Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index). National, regional, and global trends in adult overweight and obesity prevalences. Popul Health Metrics. 2012;10(1):22. doi:10.1186/1478-7954-10-22.CrossRef

Bult MJ, van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol. 2008;158(2):135–45. doi:10.1530/EJE-07-0145.CrossRefPubMed

Padwal R, Klarenbach S, Wiebe N, Hazel M, Birch D, Karmali S, Sharma AM, Manns B, Tonelli M. Bariatric surgery: a systematic review of the clinical and economic evidence. J Gen Intern Med. 2011;26(10):1183–94. doi:10.1007/s11606-011-1721-x.CrossRefPubMedPubMedCentral

Sussenbach SP, Padoin AV, Silva EN, Benzano D, Pufal MA, Barhouch AS, Chatkin R, Ramos RJ, Balestro A, Mottin CC. Economic benefits of bariatric surgery. Obes Surg. 2012;22(2):266–70. doi:10.1007/s11695-011-0558-z.CrossRefPubMed

Nguyen NT, DeMaria E, Ikkramuddin S, et al., editors. The SAGES manual: a practical guide to bariatric surgery. New York: Springer; 2008.

Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32. doi:10.1007/s11695-015-1657-z.CrossRefPubMed

Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183(6):630–41 .ReviewCrossRefPubMed

the ERAS Group, Nygren J, Soop M, Thorell A, Hausel J, Ljungqvist OM. An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients. Dis Colon rectum. 2009;52(5):978–85. doi:10.1007/DCR.0b013e31819f1416.

10.

Coolsen MME, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CHC. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on Pancreaticoduodenectomies. World J Surg. 2013;37(8):1909–18.CrossRefPubMed

11.

Yu Z, Zhuang C-L, Ye X-Z, Zhang C-J, Dong Q-T, Chen B-C. Fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis. Langenbeck's Arch Surg. 2014;399(1):85–92.CrossRef

12.

Teeuwen PH, Bleichrodt RP, Strik C, Groenewoud JJ, Brinkert W, van Laarhoven CJ, van Goor H, Bremers AJ. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg. 2010;14(1):88–95. doi:10.1007/s11605-009-1037-x.CrossRefPubMed

13.

Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;16(2):CD007635. doi:10.1002/14651858.CD007635.pub2 .Review

14.

Grantcharov TP, Kehlet H. Laparoscopic gastric surgery in an enhanced recovery programme. Br J Surg. 2010;97(10):1547–51. doi:10.1002/bjs.7184.CrossRefPubMed

15.

Thomas WP, Alan DW, Niki JS, Stephen GD, Peter AL. Simplified fast-track laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2015;25(3):413–7. doi:10.1007/s11695-014-1408-6.CrossRef

16.

Dogan K, Kraaij L, Aarts EO, Koehestanie P, Hammink E, van Laarhoven CJ, Aufenacker TJ, Janssen IM, Berends FJ. Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care. Obes Surg. 2015;25(1):28–35. doi:10.1007/s11695-014-1355-2.CrossRefPubMed

17.

Bamgbade OA, Adeogun BO, Abbas K. Fast-track laparoscopic gastric bypass surgery: outcomes and lessons from a bariatric surgery service in the United Kingdom. Obes Surg. 2012;22:398–402. doi:10.1007/s11695-011-0473-3.CrossRefPubMed

18.

McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242:494–501 .discussion 498-501PubMedPubMedCentral

19.

Elliot JA, Patel VM, Kirresh A, et al. Fast-track laparoscopic bariatric surgery: a systematic review. Updat Surg. 2013;65:85–94. doi:10.1007/s13304-012-0195-7.CrossRef

20.

Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes. 2007;31(4):569–77.

21.

Arru L, Azagra JS, Goergen M, Legrand A, Orlando GG, Poulain V. Percutaneous and reduced-port Roux-en-Y gastric bypass: technical aspects. J Am Coll Surg. 2013;217(2):e1–8. doi:10.1016/j.jamcollsurg.2013.04.019.CrossRefPubMed

22.

Arru L, Azagra JS, Goergen M, de Blasi V, de Magistris L, Facy O. Three-port laparoscopic sleeve gastrectomy: feasibility and short outcomes in 25 consecutives super-obese patients. Cir Esp. 2013;91(5):294–300. doi:10.1016/j.ciresp.2012.10.003.CrossRefPubMed

23.

Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med. 2010;83:11–25.PubMedPubMedCentral

24.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral

25.

Saravanakumar K, Rao SG, Cooper GM. Obesity and obstetric anaesthesia. Anaesthesia. 2006;61(1):36–48.CrossRefPubMed

26.

Schlug SA, Rayman A. Postoperative pain management of the obese patient. Best Pract Res Clin Anaesthesiol. 2011;25(1):73–81.CrossRef

27.

: Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anaesthesiologists Task Force on Acute Pain Management. Anaestesiology. 2012;116(2):248–273. doi:10.1097/ALN.0b013e31823c1030

28.

Freeman AL, Pendleton RC, Rondina MT. Prevention of venous thromboembolism in obesity. Expert Rev Cardiovasc Ther. 2010;8(12):1711–21. doi:10.1586/erc.10.160.CrossRefPubMedPubMedCentral

29.

Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update. Curr Opin Clin Nutr Metab Care. 2001;4:255–9.CrossRefPubMed

30.

: Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003;CD004423.

31.

Khoury W, Dakwar A, Sivkovits K, Mahajna A. Fast-track rehabilitation accelerates recovery after laparoscopic colorectal surgery. JSLS. 2014;18(4). doi:10.4293/JSLS.2014.00076.

32.

: Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24 h of colorectal surgery versus later commencement of feeding for postoperative complications.

33.

Csendes A. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2004;18:559 .author reply 560CrossRefPubMed

34.

Warschkow R, Tarantino I, Folie P, Beutner U, Schmied BM, Bisang P, Schultes B, Thurnheer M. C-reactive protein 2 days after laparoscopic gastric bypass surgery reliably indicates leaks and moderately predicts morbidity. J Gastrointest Surg. 2012;16(6):1128–35. doi:10.1007/s11605-012-1882-x.CrossRefPubMed

Title: Fast-Track in Bariatric and Metabolic Surgery: Feasibility and Cost Analysis Through a Matched-Cohort Study in a Single Centre
Authors: Vincenzo Simonelli
Martine Goergen
Gennaro G. Orlando
Luca Arru
Charalampos A. Zolotas
Maxim Geeroms
Virginie Poulain
Juan S. Azagra
Publication date: 01-08-2016
Publisher: Springer US
Published in: Obesity Surgery / Issue 8/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-016-2255-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Fast-Track in Bariatric and Metabolic Surgery: Feasibility and Cost Analysis Through a Matched-Cohort Study in a Single Centre

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2016

Duodenal-Jejunal Bypass Preferentially Elevates Serum Taurine-Conjugated Bile Acids and Alters Gut Microbiota in a Diabetic Rat Model

Postoperative Mortality After Bariatric Surgery: Do the Numbers Reflect the Reality?

Total Weight Loss as the Outcome Measure of Choice After Roux-en-Y Gastric Bypass

Comparison of Preoperative Diets Before Bariatric Surgery: a Randomized, Single-Blinded, Non-inferiority Trial

Reply to the Article Chen CY. et al. “Laparoscopic Conversion of Gastric Bypass Complication to Sleeve Gastrectomy: Technique and Early Results.” Obes Surg. 2016 Jan 19. [Epub ahead of Print]

Relationship Between Tobacco Use and Weight Loss After Bariatric Surgery