Abstract
Bariatric surgery is the only evidence-based and long-term treatment for morbid obesity across a wide range of patient types. However, the increased demand for bariatric surgery raises a number of key issues, the foremost of which is the concern about peri- and postoperative outcome in this high-risk patient group. The increased demand may also put enormous pressure on limited health, economic, and surgical resources especially at the operating room (OR) level. The “Enhanced Recovery After Surgery” or fast-track approach, which is standard practice in colorectal surgery, may provide a novel strategy aimed at optimizing the peri- and postoperative management of patients as well as increasing throughput in the OR. The implementation of a fast-track protocol for bariatric surgery at the Catherina Hospital, Eindhoven, The Netherlands, resulted in improvement in many aspects of service provision. Overall time in the OR was reduced together with length of hospital stay, resulting in a saving of approximately €2,300 per procedure. Very importantly these efficiencies have been achieved with no negative impact on patient care. Other benefits of having a dedicated surgical team, OR staff, and operating time include improvements in teamwork and the safety environment. This case study has demonstrated that the key to successful implementation of a fast-track protocol is the management of the change process and also setting realistic timelines.
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Notes
- 1.
Morbid obesity = BMI >35 together with comorbidities
References
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737
Eisenberg D, Bellatorre A, Bellatorre N (2013) Sleeve gastrectomy as a stand-alone bariatric operation for severe, morbid, and super obesity. JSLS 17:63–67
Vu L, Switzer NJ, De Gara C, Karmali S (2013) Surgical interventions for obesity and metabolic disease. Best Pract Res Clin Endocrinol Metab 27:239–246
Anselmino M, Bammer T, Fernández Cebrián JM, Daoud F, Romagnoli G, Torres A (2009) Cost effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries (II). Obes Surg 19:1542–1549
Mullen DM, Marr TJ (2010) Longitudinal cost experience for gastric bypass patients. Surg Obes Relat Dis 6:243–248
Powers KA, Rehrig ST, Jones DB (2007) Financial impact of obesity and bariatric surgery. Med Clin North Am 91:321–338
Keating CL, Dixon JB, Moodie ML, Peeters A, Bulfone L, Maglianno DJ, O’Brien PE (2009) Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diabetes Care 32:567–574
National Center for Health Statistics NHANES IV Report. Available at: http://www.cdc.gov/nchs/product/pubs/pubd/hestats/obes/obese99.htm2002. Accessed 15 July 2013
Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288:1723–1727
Sturm R (2003) Increases in clinically severe obesity in the United States, 1986–2000. Arch Intern Med 163:2146–2148
Smulders F (2012) Fast-track program in bariatric surgery: do we need any other good reason to start? AIMS Academy, Advanced Laparoscopic Course for Bariatric Surgery. Milan, 17–19 Oct
Office for Economic Co-operation (2011). Health at a glance 2011: OECD indicators. http://www.oecd-ilibrary.org/sites/health_glance-2011-en. Accessed 15 July 2013
International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Are you a candidate? http://www.ifso.com/Index.aspx?id=Areyouacandidate. Accessed 15 July 2013
Buchwald H, Oien DM (2009) Metabolic/bariatric surgery worldwide 2008. Obes Surg 19:1605–1611
Jacobsen HJ, Bergland A, Raeder J, Gislason HG (2012) High-volume bariatric surgery in a single center: safety, quality, cost-efficacy and teaching aspects in 2,000 consecutive cases. Obes Surg 22:158–166
Buise MP, Van den Broek RJC, de Zoete JP, Bindels AJ (2010) Advanced care admission following bariatric surgery. Neth J Crit Care 14:85–91
ERAS Society (2013) History of the ERAS Society. http://www.erassociety.org/index.php/about-us/history. Accessed 15 July 2013
Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, Nygren J, Hausel J, Soop M, Andersen J, Kehlet H (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477
ERAS Society (2013) Welcome to the official ERAS website. http://www.erassociety.org. Accessed 15 July 2013
Varandhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recover after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized trials. Clin Nutr 29:434–440
US National Library of Medicine National Institutes of Health (2013) Search results. http://www.ncbi.nlm.nih.gov/pubmed?term=fast-track%20in%20colorectal%20surgery. Accessed 15 July 2013
US National Library of Medicine National Institutes of Health (2013) Search results. http://www.ncbi.nlm.nih.gov/pubmed?term=fast-track%20in%20bariatric%20surgery. Accessed 15 July 2013
Frezza EE (2006) Six steps to fast-track insurance approval for bariatric surgery. Obes Surg 16:659–663
Bergland A, Gislason H, Raeder J (2008) Fast-track surgery for bariatric laparoscopic gastric bypass with focus on anaesthesia and peri-operative care. Experience with 500 cases. Acta Anaesthesiol Scand 52:1394–1399
Han LO, Zhou LH, Cheng SJ, Song C, Song CF (2011) Key details of the duodenal-jejunal bypass in type 2 diabetes mellitus rats. World J Gastroenterol 17:5021–5027
Sommer T, Larsen JF, Raundahl U (2011) Eliminating learning curve-related morbidity in fast track laparoscopic Roux-en-Y gastric bypass. J Laparoendosc Adv Surg Tech A 21:307–312
Bamgbade OA, Adeogun BO, Abbas K (2012) Fast-track laparoscopic gastric bypass surgery: outcomes and lessons from a bariatric surgery service in the United Kingdom. Obes Surg 22:398–402
Lemanu DP, Srinivasa S, Singh PP, Johannsen S, MacCormick AD, Hill AG (2012) Optimizing perioperative care in bariatric surgery patients. Obes Surg 22:979–990
Carron M, Veronese S, Foletto M, Ori C (2013) Sugammadex allows fast-track bariatric surgery. Obes Surg 23:1558–1563
Elliott JA, Patel VM, Kirresh A, Ashrafian H, Le Roux CW, Olbers T, Athanasiou T, Zacharakis E (2013) Fast-track laparoscopic bariatric surgery: a systematic review. Updates Surg 65:85–94
Sosada K, Wiewiora M, Piecuch J, Zurawiński W (2013) Fast track in large intestine surgery – review of randomized clinical trials. Wideochir Inne Tech Malo Inwazyjne 8:1–7
Berende CA, de Zoete JP, Smulders JF, Nienhuijs SW (2012) Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery. Obes Surg 22:330–334
van den Broek RJ, Buise MP, van Dielen FM, Bindels AJ, van Zundert AA, Smulders JF (2009) Characteristics and outcome of patients admitted to the ICU following bariatric surgery. Obes Surg 19:560–564
DeMaria EJ, Portenier D, Wolfe L (2007) Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis 3:134–140
DeMaria EJ, Murr M, Byrne TK, Blackstone R, Grant JP, Budak A, Wolfe L (2007) Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg 246:578–582; discussion 583–584
Stepaniak PS, Heij C, Buise MP, Mannaerts GHH, Smulders JF, Nienhuijs SW (2012) Bariatric surgery with operating room teams that stayed fixed during the day: a multicenter study analyzing the effects on patient outcomes, teamwork and safety climate, and procedure duration. Anesth Analg 115:1384–1392
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Smulders, J.F., Jakimowicz, J.J., Buise, M.P. (2014). Surgical Practicalities: Fast-Track Lessons from a Bariatric Surgery Unit. In: Foletto, M., Rosenthal, R. (eds) The Globesity Challenge to General Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-5382-3_6
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DOI: https://doi.org/10.1007/978-88-470-5382-3_6
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