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

Simonelli, Vincenzo; Goergen, Martine; Orlando, G.; Arru, Luca; Zolotas, Charalampos A.; Geeroms, Maxim; Poulain, Virginie; Azagra, Juan Santiago

doi:10.1007/s11695-016-2255-4

Cited by 39 publications

(26 citation statements)

References 34 publications

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“…Ideally, ERABS is combined with preoperative prehabilitation and comorbidity optimization, as well as evidence‐based intraoperative clinical pathways . Implementation of ERABS in patients decreases length of hospital stay without increasing morbidity, readmission rates , or postdischarge resource utilization .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

326

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

326

464

View full text Add to dashboard Cite

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“…Similar studies are available for laparoscopic Roux-en-Y gastric bypass (11). Furthermore, thanks to the ERAS protocol, the cost of treatment can be cut down, proving cost-effectiveness of ERAS strategy (12). In our experience ERAS protocol is a safe and well tolerated solution.…”

Section: Enhanced Recovery After Surgery (Eras)mentioning

confidence: 55%

Innovative solutions in bariatric surgery

et al. 2016

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“…The one-stage surgical approach seems to be as safe as two-stage, yet there are only a few studies evaluating these approaches [23]. The LOS after revisional surgery is longer than standard LOS after primary bariatric surgery (4.18 days), but over the years, following the learning curve, it was possible to reduce LOS to 3.25 days in 2014 [24]. …”

Section: Discussionmentioning

confidence: 99%

Revisional bariatric surgery after failed laparoscopic adjustable gastric banding - a single-center, long-term retrospective study.

Kowalewski¹,

Olszewski²,

Paśnik³

2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionLaparoscopic adjustable gastric banding (LAGB) used to be one of the most popular bariatric procedures.AimTo present our institution’s experience with LAGB, its complications, causes of failure and revisional bariatric procedures, in a long-term follow-up.Material and methodsRecords of patients who underwent pars flaccida LAGB from 2003 to 2006 were gathered. We selected data on patients with a history of additional bariatric procedures. Their initial demographic data, body mass index and causes of revision were gathered. We analyzed length of stay and early perioperative complications.Results60% of patients (n = 57) who underwent LAGB in our institution between 2003 and 2006 had their band removed (out of 107, 11% lost to follow-up). Median time to revisional surgery was 50 months. The main reasons for removal were: weight regain (n = 23; 40%), band slippage (n = 14; 25%), and pouch dilatation (n = 9; 16%). Thirty (53%) patients required additional bariatric surgery, 10 (33%) of which were simultaneous with band removal. The most popular procedures were: laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 15; 50%), open gastric bypass (n = 8; 27%), and laparoscopic sleeve gastrectomy (LSG) – (n = 3; 10%). Mean length of stay (LOS) was 5.4 ±2.0. One (3%) perioperative complication was reported.ConclusionsThe results show that LAGB is not an effective bariatric procedure in long-term follow-up due to the high rate of complications causing band removal and the high rate of obesity recurrence. Revisional bariatric surgery after failed LAGB may be performed in a one-stage approach with band removal.

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

Cited by 39 publications

References 34 publications

Innovative solutions in bariatric surgery

Revisional bariatric surgery after failed laparoscopic adjustable gastric banding - a single-center, long-term retrospective study.

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