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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2017 Dec 13

DOI: 10.23736/S0375-9393.17.12298-4


lingua: Inglese

The safety and efficiency of a fast-track protocol for sleeve gastrectomy: a team approach

Sebastiaan J. VREESWIJK 1, Pim W. van RUTTE 2, Simon W. NIENHUIJS 2, R. Arthur BOUWMAN 3, J. Frans SMULDERS 2, Marc P. BUISE 1, 3

1 ICU, Catharina Hospital, Eindhoven, The Netherlands; 2 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands; 3 Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands


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 anaesthetic agents, a multi-modal pain protocol to reduce opioids, and early mobilisation. The main parameters for safety were intraoperative, early and late postoperative complications. Procedure time and hospital stay were used to evaluate efficiency.
RESULTS: 805 patients were included, 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.

KEY WORDS: Fast-track - Bariatric surgery - Sleeve gastrectomy - Safety - Complications - Anaesthesia

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Publication History

Article first published online: December 13, 2017
Manuscript accepted: December 12, 2017
Manuscript revised: November 21, 2017
Manuscript received: July 13, 2017

Per citare questo articolo

Vreeswijk SJ, 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 Dec 13. DOI: 10.23736/S0375-9393.17.12298-4

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