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The Standardized Postoperative Checklist for Bariatric Surgery; a Tool for Safe Early Discharge?

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Abstract

Background

Morbidly obese patients are at higher risk of complications after surgery. In bariatric surgery, pre- and intra-operative checklists are commonly used to identify high-risk patients preoperatively, to decrease the number of postoperative complications. This pilot study evaluates the effect of a postoperative checklist in bariatric surgery, addressing regularly measured parameters, on the occurrence and early recognition of complications.

Methods

An in-house developed postoperative checklist was used on the first postoperative day after bariatric surgery and included information on nausea, pain, temperature, heart rate, and laboratory markers. Complications were scored using the Clavien-Dindo (CD) classification, and three groups were formed: no complications (CD0), minor complications (CD1 and 2), and major complications (≥CD3a). Differences between groups were analyzed using nonparametric tests.

Results

Six hundred ninety-four subjects were included (79.5% female, age 42.6 ± 10.8 years, BMI 43.8 ± 5.8 kg/m2). Twenty-nine subjects developed major complications within 30 days postoperatively. There were no significant differences in baseline characteristics between groups. Subjects with major complications were less willing to be discharged due to complaints, compared to subjects with no or minor complications (14.8 vs. 3.6 and 4.6%, respectively) and had a higher decrease of hemoglobin level (0.8 vs. 0.6 and 0.65 mmol/l, respectively).

Conclusion

The patient’s willingness for discharge, in combination with hemoglobin decrease, may be the best early predictors of major complications after bariatric surgery. This postoperative checklist may be an adequate instrument to identify patients who can be safely discharged home on the first postoperative day and thereby play a part in patient management after bariatric surgery.

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Authors and Affiliations

  1. Department of Surgery, Franciscus Gasthuis & Vlietland, PO Box 10900, 3004 BA, Rotterdam, The Netherlands

    Stefanie R. van Mil, Lucia E. Duinhouwer, Guido H. H. Mannaerts, L. Ulas Biter, Martin Dunkelgrun & Jan A. Apers

Authors
  1. Stefanie R. van Mil
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  2. Lucia E. Duinhouwer
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  3. Guido H. H. Mannaerts
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  4. L. Ulas Biter
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  5. Martin Dunkelgrun
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  6. Jan A. Apers
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Corresponding author

Correspondence to Stefanie R. van Mil.

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Informed Consent

Informed consent was obtained from all individual participants included in the study.

Human and Animal Rights Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of Interest

The authors declare that they have no conflict of interest.

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For this type of study, formal consent is not required.

Additional information

Stefanie R. van Mil and Lucia E. Duinhouwer are equally contributing authors

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van Mil, S.R., Duinhouwer, L.E., Mannaerts, G.H.H. et al. The Standardized Postoperative Checklist for Bariatric Surgery; a Tool for Safe Early Discharge?. OBES SURG 27, 3102–3109 (2017). https://doi.org/10.1007/s11695-017-2746-y

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  • DOI: https://doi.org/10.1007/s11695-017-2746-y

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