Fast Track Care for Gastric Bypass Patients Decreases Length of Stay Without Increasing Complications in an UnselectedPatient Cohort
Retrospective studies investigating fast track care involve selected patients. This study evaluates the implementation of fast track care in unselected bariatric patients in a high volume teaching hospital in the Netherlands.
Consecutive patients who underwent a primary laparoscopic gastric bypass in our center were reviewed in the years before (n = 104) and after implementation of fast track care (n = 360). Fast track involved the banning of tubes/catheters, anesthetic management and early ambulation. Primary outcome was the length of stay. Perioperative times, complications (<30 days), readmissions and prolonged length of stay were secondary outcomes.
The median length decreased after implementation of fast track (3 days versus 1 day, p < 0.001). Overall complication rate remained stable after implementation of fast track care (17.3 % versus 18.3 %, not significant). Readmission rate did not differ between groups (4.8 % conventional care versus 8.1 % fast track, not significant). More grades I–IVa complications occurred outside the hospital after the implementation of fast track care (24.8 % versus 51.5 %). Lower age (b = 0.118, 95 % CI: 0.002–0.049, p < 0.05) and the implementation of fast track (b = −0.270, 95 % CI: -1.969 to −0.832, p < 0.001) were the only factors that significantly shortened the length of stay.
Patients that received fast track care had a decreased length of stay. Although more complications occurred after discharge in the fast track care group, this did not lead to adverse outcomes. Fast track does enhance recovery and is suitable for unselected patients. Care providers should select their patients for early discharge and pursue a low threshold for readmission.
KeywordsGastric bypass Fast track Enhanced recovery Early discharge
- 3.Vlug MS, Wind J, Hollmann MW, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery. Ann Surg. 2011;254(6):868–75. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-201112000-00007. Accessed 2012 May 7.Google Scholar
- 5.Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg. 2004;240(2):205–13. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-200408000-00003. Accessed 2013 Sep 17.Google Scholar
- 8.McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery. Trans Meeting Am Surg Assoc. 2005;123:188–95. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00153307-200501230-00020. Accessed 2012 May 7.Google Scholar
- 10.DBC Information System. Dutch Hospital Data. 2012.Google Scholar
- 11.White PF, Kehlet H, Neal JM, et al. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Anal. 2007;104(6):1380–96. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000539-200706000-00013. Accessed 2012 May 4.
- 13.Dumon KR, Murayama KM. Bariatric surgery outcomes. Surg Clin North Am. 2011;91(6):1313–38, x. http://www.ncbi.nlm.nih.gov/pubmed/22054156. Accessed 2012 Oct 29.
- 14.Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.Google Scholar
- 19.Haddad A, Tapazoglou N, Singh K, et al. Role of intraoperative esophagogastroenteroscopy in minimizing gastrojejunostomy-related morbidity: experience with 2,311 laparoscopic gastric bypasses with linear stapler anastomosis. Obesity Surg. 2012;22(12)1928–33. http://www.ncbi.nlm.nih.gov/pubmed/22941393. Accessed 2012 Nov 7.
- 20.Shikora SA, Kim JJ, Tarnoff ME, et al. Laparoscopic Roux-en-Y gastric bypass: results and learning curve of a high-volume academic program. Arch Surg. 2005;140(4):362–7.Google Scholar
- 21.Suter M, Donadini A, Romy S, Demartines N, Giusti V. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg 2011;254(2):267–73. http://www.ncbi.nlm.nih.gov/pubmed/21772127. Accessed 2012 Nov 7.
- 23.Omalu BI, Ives DG, Buhari AM, et al. Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004. Arch Surg (Chicago, IL: 1960). 2007;142(10):923–8. discussion 929.Google Scholar
- 26.Morton JM, DeMaria E, Winegar D, Sherif B, Hutcher N, Blackstone R, et al. PL-110 Is ambulatory laparoscopic Roux-en-Y gastric bypass from the bariatric outcomes longitudinal database (BOLD) associated with higher adverse events? Surg Obes Rel Dis 2011 ;7(3):342–3. http://linkinghub.elsevier.com/retrieve/pii/S1550728911003340. Accessed 2013 Sep 17.