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Fast Track Program in Conversion Bariatric Surgery, as Safe as in Primary Bariatric Surgery?

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Abstract

Objectives

Evaluate the safety of fast track (FT) surgery program in patients undergoing primary and revisional bariatric surgery (conversion from one procedure to another); identify limiting factors for early discharge and predictive factors for readmission.

Methods

This is a retrospective review of 730 consecutive morbidly obese patients who underwent bariatric surgery between January 2016 and December 2017. Fast track protocol was applied on all patients. Target discharge was after one-night stay. The primary end point is length of stay. The secondary end point is frequency of hospital contact after discharge, readmissions and reinterventions within 30 days.

Results

Primary procedures (n = 633) were banded Roux-en-Y gastric bypass (BRYGB, 79.3%), sleeve gastrectomy (10.7%), gastric band (4.7%) and others (5.3%). Mean age (± SD) was 44.32 ± 11.26 years, and mean BMI (± SD) was 43.58 ± 6.12 kg/m2. Conversion procedures (n = 97) were gastric band to BRYGB (40.2%), or to adjustable BRYGB (39.2%), Mason to BRYGB (11.3%), sleeve to BRYGB (4.1%) and others (5.2%). Mean age (± SD) was 47.22 ± 9.1 years, and mean BMI (± SD) was 37.9 ± 7.27 kg/m2. Mean LOS in primary patients was 1.3 ± 0.99, and that in conversion patients was 1.5 ± 1.4. Successful discharge at one night or less was achieved in 650 cases (573 primary and 77 conversion). After one-night discharge, incidence of contact to the hospital, readmission and reintervention was 23.9%, 5.9% and 1.9%, in the primary group and 31.2%, 13% and 5.2% in the conversion group.

Conclusion

One-night discharge in FT managed conversion procedures is safe, compared to primary procedures. It is associated with higher readmission rates; however, the postdischarge hospital contacts and surgical complications were not statistically significant different.

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Acknowledgements

I would like to thank the team at Dutch Obesity Clinic South, Heerlen, The Netherlands, for their support and important assistance for the data collection.

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Authors and Affiliations

  1. Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands

    Abdelrahman Mohammad Galal, Evert-Jan Boerma, Sofie Fransen, Berry Meesters & Jan Willem Greve

  2. Dutch Obesity Clinic South, Heerlen, The Netherlands

    Abdelrahman Mohammad Galal, Evert-Jan Boerma, Sofie Fransen, Berry Meesters & Jan Willem Greve

  3. Maastricht University Medical Center, Maastricht, The Netherlands

    Abdelrahman Mohammad Galal, Steven Olde Damink & Jan Willem Greve

  4. Department of General Surgery, Sohag Faculty of Medicine, Sohag University Hospitals, Sohag, Egypt

    Abdelrahman Mohammad Galal

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  1. Abdelrahman Mohammad Galal
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Correspondence to Abdelrahman Mohammad Galal or Jan Willem Greve.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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. The study was judged by the Ethics Committee of the Zuyderland Medical Center and was considered not to be Research Involving the Human Subjects Act.

Informed Consent

The study does not include any identifiable information. Retrospective data analysis does not require informed consent; however, all patients gave consent for use of the data before the treatment.

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Galal, A.M., Boerma, EJ., Fransen, S. et al. Fast Track Program in Conversion Bariatric Surgery, as Safe as in Primary Bariatric Surgery?. OBES SURG 30, 1291–1302 (2020). https://doi.org/10.1007/s11695-019-04268-7

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  • DOI: https://doi.org/10.1007/s11695-019-04268-7

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