Surgical Practicalities: Fast-Track Lessons from a Bariatric Surgery Unit

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.