The Standardized Postoperative Checklist for Bariatric Surgery; a Tool for Safe Early Discharge?
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.
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.
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).
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.
KeywordsBariatric surgery Sleeve gastrectomy Roux-en-Y gastric bypass Postoperative complications Complications Postoperative checklist Discharge criteria Early discharge Prediction of complications
- 1.Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol. Assess. [Internet]. 2009 [cited 2014 Jul 10];13:1–190, 215–357, iii–iv. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19726018.
- 2.Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane database Syst. Rev. [Internet]. 2009 [cited 2014 Sep 17];CD003641. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19370590.
- 3.Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am. J. Med. [Internet]. Elsevier Inc.; 2009 [cited 2014 Jul 10];122:248–256.e5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19272486.
- 4.Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N. Engl. J. Med. [Internet]. 2007 [cited 2014 Sep 10];357:741–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17715408.
- 5.Bamgbade OA, Adeogun BO, Abbas K. Fast-track laparoscopic gastric bypass surgery: outcomes and lessons from a bariatric surgery service in the United Kingdom. Obes. Surg. [Internet]. 2012;22:398–402. Available from: http://link.springer.com/10.1007/s11695-011-0473-3.
- 7.Gillespie BM, Chaboyer W, Thalib L, et al. Effect of using a safety checklist on patient complications after surgery: a systematic review and meta-analysis. Anesthesiology [Internet]. 2014;120:1380–9. Available from: http://sfxhosted.exlibrisgroup.com/hinc?sid=OVID:medline&id=pmid:24845919&id=doi:10.1097/ALN.0000000000000232&issn=0003-3022&isbn=&volume=120&issue=6&spage=1380&pages=1380-9&date=2014&title=Anesthesiology&atitle=Effect+of+using+a+safety+checklist+on+patie.
- 8.Gadiot RPM, Biter LU, Zengerink HJF, et al. Laparoscopic sleeve gastrectomy with an extensive posterior mobilization: technique and preliminary results. Obes. Surg. [Internet]. 2012 [cited 2014 Sep 17];22:320–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21826582.
- 9.Leifsson BG, Gislason HG. Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients. Obes. Surg. [Internet]. 2005;15:35–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15760497.
- 11.Mannaerts GHH, van Mil SR, Stepaniak PS, et al. Results of implementing an enhanced recovery after bariatric surgery (ERABS) protocol. Obes. Surg. [Internet]. 2015; Available from: http://www.ncbi.nlm.nih.gov/pubmed/26003552.
- 13.Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann. Surg. [Internet]. 2009 [cited 2014 Sep 14];250:187–96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19638912.
- 14.Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann. Surg. [Internet]. 2004 [cited 2014 Jul 9];240:205–13. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-200408000-00003.
- 15.Singh PM, Panwar R, Borle A, et al. Efficiency and safety effects of applying ERAS protocols to bariatric surgery: a systematic review with meta-analysis and trial sequential analysis of evidence. Obes. Surg. [Internet]. 2016; Available from: http://link.springer.com/10.1007/s11695-016-2442-3.
- 16.Małczak P, Pisarska M, Piotr M, et al. Enhanced recovery after bariatric surgery: systematic review and meta-analysis. Obes. Surg. [Internet]. 2016; Available from: http://link.springer.com/10.1007/s11695-016-2438-z.