Department of Digestive Surgery, Amiens University Hospital, Amiens Cedex 01, France.
Department of Anaesthesiology, Amiens University Hospital, Amiens Cedex 01, France.
Surg Obes Relat Dis. 2019 Apr;15(4):534-545. doi: 10.1016/j.soard.2019.02.005. Epub 2019 Feb 14.
Few series have demonstrated the feasibility of laparoscopic sleeve gastrectomy (SG) as day-case surgery (DCS).
Compare the outcomes and healthcare costs of SG performed as DCS or as an inpatient procedure.
University Hospital, France, public practice.
This was a prospective, nonrandomized study of 250 consecutive patients undergoing day-case SG from May 2011 to June 2017. Each patient in the DCS group (n = 250) was manually paired by sex, age, body mass index, preoperative co-morbidities, and year of surgery with 1 patient undergoing SG as an inpatient procedure (SG control group, n = 250). Patients in the SG control group were excluded from DCS on the basis of DCS criteria. The primary endpoint of this study was the clinical and economic impact of performing SG as DCS compared with inpatient management. The secondary endpoints were related to DCS, DCS satisfaction rate, comparison of outcomes and costs between DCS and inpatient procedures, and the changing modalities of SG as DCS in our institution (by comparing the first 100 patients to the last 150 patients).
A total of 1573 patients underwent SG during the period, 250 patients underwent SG as DCS (15.9%) and 554 patients were excluded on the basis of DCS criteria. No postoperative deaths, 19 overnight admissions (7.6%), 16 unscheduled consultations (6.4%), and 12 unscheduled hospitalizations (4.8%) were observed in the DCS group. No significant differences were observed in postoperative complications. Readmission was higher in the DCS group (5.6% versus 4%; P < .001), while the length of rehospitalization was shorter in the DCS group (5.8 versus 10.8 d; P < .001). Overall cost and cost per patient were significantly lower in the DCS group (P < .001).
Day-case SG on selected patients was not associated with increased morbidity and mortality rates and was cost-effective due to the low cost of management of postoperative complications.
少数研究已经证实了腹腔镜袖状胃切除术（LSG）作为日间手术（DCS）的可行性。
比较 LSG 作为 DCS 或住院手术的治疗效果和医疗成本。
法国大学医院，公共医疗场所。
这是一项前瞻性、非随机的研究，纳入了 2011 年 5 月至 2017 年 6 月期间接受 DCS 下 LSG 的 250 例连续患者。DCS 组（n=250）的每位患者都通过性别、年龄、体重指数、术前合并症和手术年份进行手动配对，与接受住院手术的 1 例 LSG 患者（LSG 对照组，n=250）配对。基于 DCS 标准，LSG 对照组的患者被排除在 DCS 之外。本研究的主要终点是与住院管理相比，将 LSG 作为 DCS 的临床和经济影响。次要终点与 DCS 相关，包括 DCS 满意度率、DCS 和住院手术之间的结果和成本比较，以及我院 DCS 下 LSG 模式的变化（通过比较前 100 例患者和最后 150 例患者）。
在此期间，共有 1573 例患者接受了 LSG，其中 250 例患者接受了 DCS（15.9%），554 例患者因 DCS 标准被排除在外。DCS 组无术后死亡、19 例过夜住院（7.6%）、16 例非计划性会诊（6.4%）和 12 例非计划性住院（4.8%）。术后并发症无显著差异。DCS 组的再入院率较高（5.6%比 4%；P<.001），但 DCS 组的再住院时间较短（5.8 天比 10.8 天；P<.001）。DCS 组的总费用和人均费用明显较低（P<.001）。
在选择的患者中，日间手术 LSG 并不增加发病率和死亡率，且由于术后并发症管理费用低，因此具有成本效益。
