Department of General Surgery, University of Tennessee Graduate School of Medicine, 1934 Alcoa Hwy, Building D, Ste 285, Knoxville, TN, USA.
Surg Endosc. 2023 Jun;37(6):4895-4901. doi: 10.1007/s00464-022-09628-6. Epub 2022 Sep 26.
The COVID-19 pandemic created delays in surgical care. The population with obesity has a high risk of death from COVID-19. Prior literature shows the most effective way to combat obesity is by weight loss surgery. At different times throughout the COVID-19 pandemic, elective inpatient surgeries have been halted due to bed availability. Recognizing that major complications following bariatric surgery are extremely low (bleeding 0-4%, anastomotic leaks 0.8%), we felt outpatient bariatric surgery would be safe for low-risk patients. Complications such as DVT, PE, infection, and anastomotic leaks typically present after 7 days postoperatively, well outside the usual length of stay. Bleeding events, severe postoperative nausea, and dehydration typically occur in the first few days postoperatively. We designed a pathway focused on detecting and preventing these early post-op complications to allow safe outpatient bariatric surgery.
We used a preoperative evaluation tool to risk stratify bariatric patients. During a 16-month period, 89 patients were identified as low risk for outpatient surgery. We designed a postoperative protocol that included IV hydration and PO intake goals to meet a safe discharge. We sent patients home with a pulse oximeter and had them self-monitor their pulse and oxygen saturation. We called all patients at 10 pm for a postoperative assessment and report of their vitals. Patients returned to clinic the following day and were seen by a provider, received IV hydration, and labs were drawn.
80 of 89 patients (89.8%) were successfully discharged on POD 0. 3 patients were readmitted within 30 days. We had zero deaths in our study cohort and no morbidity that would have been prevented with postoperative admission.
We demonstrate that by identifying low-risk patients for outpatient bariatric surgery and by implementing remote monitoring of vitals early outpatient follow-up, we were able to safely perform outpatient bariatric surgery.
COVID-19 大流行导致外科手术延迟。肥胖人群患 COVID-19 死亡的风险很高。先前的文献表明，对抗肥胖最有效的方法是通过减肥手术。在 COVID-19 大流行的不同时期，由于床位供应，择期住院手术已停止。鉴于减重手术后的主要并发症发生率极低（出血 0-4%，吻合口漏 0.8%），我们认为低风险患者行门诊减重手术是安全的。深静脉血栓形成、肺栓塞、感染和吻合口漏等并发症通常在术后 7 天出现，远远超出了通常的住院时间。出血事件、严重的术后恶心和脱水通常发生在术后几天内。我们设计了一种专注于检测和预防这些术后早期并发症的途径，以实现安全的门诊减重手术。
我们使用术前评估工具对减重患者进行风险分层。在 16 个月期间，有 89 名患者被确定为门诊手术的低风险。我们设计了术后方案，包括静脉补液和口服摄入目标，以实现安全出院。我们给患者带回家脉搏血氧仪，让他们自行监测脉搏和血氧饱和度。我们在晚上 10 点给所有患者打电话进行术后评估和生命体征报告。患者在第二天返回诊所，由医生就诊，接受静脉补液，并进行实验室检查。
89 名患者中有 80 名（89.8%）成功在术后第 0 天出院。3 名患者在 30 天内再次入院。我们的研究队列中没有死亡病例，也没有因术后住院而可预防的发病率。
我们证明，通过确定门诊减重手术的低风险患者，并通过早期远程监测生命体征来实施门诊随访，我们能够安全地进行门诊减重手术。
