Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
Dutch Obesity Clinic South, Heerlen, The Netherlands.
Obes Surg. 2020 Apr;30(4):1291-1302. doi: 10.1007/s11695-019-04268-7.
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.
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.
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/m. 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/m. 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.
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.
评估在接受原发性和复发性减重手术（从一种手术转换为另一种手术）的患者中实施快速通道（FT）手术方案的安全性；确定提前出院的限制因素和再入院的预测因素。
这是一项回顾性研究，共纳入了 2016 年 1 月至 2017 年 12 月期间接受减重手术的 730 例病态肥胖患者。所有患者均采用快速通道方案。目标出院时间为 1 晚。主要终点为住院时间。次要终点为出院后医院接触频率、30 天内再入院和再介入。
初次手术（n=633）为带 Roux-en-Y 胃旁路术（BRYGB，79.3%）、袖状胃切除术（10.7%）、胃束带术（4.7%）和其他术式（5.3%）。平均年龄（±SD）为 44.32±11.26 岁，平均 BMI（±SD）为 43.58±6.12kg/m。转换手术（n=97）为胃束带 BRYGB（40.2%）、可调 BRYGB（39.2%）、Mason 至 BRYGB（11.3%）、袖状胃 BRYGB（4.1%）和其他术式（5.2%）。平均年龄（±SD）为 47.22±9.1 岁，平均 BMI（±SD）为 37.9±7.27kg/m。初次手术患者的平均 LOS 为 1.3±0.99，转换手术患者的平均 LOS 为 1.5±1.4。650 例（573 例初次手术和 77 例转换手术）成功在 1 晚或更短时间内出院。在 1 晚出院后，初次手术组的医院接触、再入院和再介入发生率分别为 23.9%、5.9%和 1.9%，转换手术组分别为 31.2%、13%和 5.2%。
与初次手术相比，FT 管理下的转换手术 1 晚出院是安全的。与初次手术相比，转换手术的再入院率较高；然而，出院后的医院接触和手术并发症并无统计学显著差异。
