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Kleipool SC, van Rutte PWJ, Eeftinck Schattenkerk LD, Bonjer HJ, Marsman HA, de Castro SMM, van Veen RN. Evaluation of Postoperative Care Protocol for Roux-en-Y Gastric Bypass Patients with Same-Day Discharge. Obes Surg 2023; 33:2317-2323. [PMID: 37347399 DOI: 10.1007/s11695-023-06697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Same-day discharge (SDD) after bariatric surgery is increasingly being performed and is safe with careful patient selection. However, detecting early complications during the first postoperative days can be challenging. We developed a postoperative care protocol for these patients and aimed to evaluate its effectiveness in detecting complications and monitoring patient recovery. METHODS A single-center retrospective observational study was conducted with patients with who underwent Roux-en-Y Gastric Bypass (RYGB) with successful SDD. The study evaluated the effectiveness of the safety net that included simple remote monitoring with a pulsoximeter and thermometer, a phone consultation on postoperative day (POD) 1, and a physical consultation on POD 2-4. Furthermore, an analysis was performed on various factors including pain scores, painkiller usage, and incidences of nausea and vomiting on POD 1. RESULTS In this study, 373 consecutive patients were included, of whom 19 (5.1%) were readmitted until POD 4. Among these, 12 patients (3.2%) reached out to the hospital themselves, while 7 (1.9%) were readmitted after phone or physical consultations. Ten of the readmitted patients had tachycardia. On POD 1, the mean numeric rating scale was 4 ± 2, and 96.6% of the patients used acetaminophen, 35.5% used naproxen, and 9.7% used oxynorm. Of the patients, 13.9% experienced nausea and 6.7% reported vomiting. CONCLUSION A postoperative care protocol for SDD after RYGB, comprising simple remote monitoring along with a phone consultation on POD 1 and a physical checkup on POD 2-4, was effective in monitoring patient recovery and detecting all early complications.
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Affiliation(s)
| | | | | | - H Jaap Bonjer
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - Ruben N van Veen
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
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Hlavin C, Ingraham P, Byrd T, Hyre N, Gabriel L, Agrawal N, Allen L, Kenkre T, Watson A, Kaynar M, Ahmed B, Courcoulas A. Clinical Outcomes and Hospital Utilization Among Patients Undergoing Bariatric Surgery With Telemedicine Preoperative Care. JAMA Netw Open 2023; 6:e2255994. [PMID: 36763357 PMCID: PMC9918871 DOI: 10.1001/jamanetworkopen.2022.55994] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/28/2022] [Indexed: 02/11/2023] Open
Abstract
Importance Bariatric surgery is the mainstay of treatment for medically refractory obesity; however, it is underutilized. Telemedicine affords patient cost and time savings and may increase availability and accessibility of bariatric surgery. Objective To determine clinical outcomes and postoperative hospital utilization for patients undergoing bariatric surgery who receive fully remote vs in-person preoperative care. Design, Setting, and Participants This cohort study comparing postoperative clinical outcomes and hospital utilization after telemedicine or in-person preoperative surgical evaluation included patients treated at a US academic hospital. Participants underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy after telemedicine or in-person preoperative surgical evaluation between July 1, 2020, to December 22, 2021, or January 1, 2018, to December 31, 2019, respectively. Follow-up was 60 days from date of surgery. Exposures Telemedicine-based preoperative care. Main Outcomes and Measures Clinical outcomes, including operating room delay, procedure duration, length of hospital stay (LOS), and major adverse events (MAE), and postoperative hospital resource utilization, including emergency department (ED) visit or hospital readmission within 30 days of the surgical procedure. Results A total of 1182 patients were included; patients in the telemedicine group were younger (mean [SD] age, 40.8 [12.5] years vs 43.0 [12.2] years; P = .01) and more likely to be female (230 of 257 [89.5%] vs 766 of 925 [82.8%]; P = .01) compared with the control group. The control group had a higher frequency of comorbidity (887 of 925 [95.9%] vs 208 of 257 [80.9%]; P < .001). The telemedicine group was found to be noninferior to the control group with respect to operating room delay (mean [SD] minutes, 7.8 [25.1]; 95% CI, 5.1-10.5 vs 4.2 [11.1]; 95% CI, 1.0-7.4; P = .002), procedure duration (mean [SD] minutes, 134.4 [52.8]; 95% CI, 130.9-137.8 vs 105.3 [41.5]; 95% CI, 100.2-110.4; P < .001), LOS (mean [SD] days, 1.9 [1.1]; 95% CI, 1.8-1.9 vs 2.1 [1.0]; 95% CI, 1.9-2.2; P < .001), MAE within 30 days (3.8%; 95% CI, 3.0%-5.7% vs 1.6%; 95% CI, 0.4%-3.9%; P = .001), MAE between 31 and 60 days (2.2%; 95% CI, 1.3%-3.3% vs 1.6%; 95% CI, 0.4%-3.9%; P < .001), frequency of ER visits (18.8%; 95% CI, 16.3%-21.4% vs 17.9%; 95% CI, 13.2%-22.6%; P = .03), and hospital readmission (10.1%; 95% CI, 8.1%-12.0% vs 6.6%; 95% CI, 3.9%-10.4%; P = .02). Conclusions and Relevance In this cohort study, clinical outcomes in the telemedicine group were not inferior to the control group. This observation suggests that telemedicine can be used safely and effectively for bariatric surgical preoperative care.
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Affiliation(s)
- Callie Hlavin
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Phoebe Ingraham
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tamara Byrd
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nathan Hyre
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lucine Gabriel
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nishant Agrawal
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura Allen
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tanya Kenkre
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew Watson
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Murat Kaynar
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bestoun Ahmed
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Beauharnais CC, Hill SS, Sturrock PR, Davids JS, Alavi K, Maykel JA. Efficacy and satisfaction of asynchronous TeleHealth care compared to in-person visits following colorectal surgical resection. Surg Endosc 2022; 36:9106-9112. [PMID: 35713720 PMCID: PMC9205288 DOI: 10.1007/s00464-022-09383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 06/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The feasibility of remote visits following abdominal colorectal surgery has not been studied in relation to efficacy, patient satisfaction, and surgeon satisfaction. This study aims to assess reliability and satisfaction with a web-based questionnaire for post-operative visits following abdominal colorectal surgery. METHODS This was a prospective single-arm cohort study at single-tertiary care center during admission for abdominal colorectal surgery. Using a web-based patient portal, patients completed a questionnaire 48 h prior to their scheduled in-person follow-up visits and submitted photographs of their incisions. Surgeons reviewed patient-entered data and responded within 24 h. Following the subsequent in-person visit, surgeons completed questionnaires to compare the accuracy of the web-based vs. in-person evaluations. Lastly, patients and surgeons completed separate satisfaction surveys after the in-person visits. RESULTS A total of 33 patients were enrolled, of which 30 (90.9%) successfully completed the web questionnaire. Providers reported the online questionnaire to be concordant with the in-person visit in 90% of cases. Of the patients who completed the study, only half found the survey alone to be acceptable for follow-up. Patients spent significantly less time completing the online questionnaire (≤ 10 min) than in-person visits, including travel time (75 min, IQR 50-100). Only 12 patients (40%) uploaded photographs of their incisions. During in-person visits, management changes were employed in four patients (13.3%), of which 3 required treatment of superficial surgical site infections (10%). CONCLUSION This asynchronous web-based visit format was acceptable to colorectal surgeons but was only embraced by half of patients, despite considerable time savings. While patients preferred in-person visits, there may be opportunities to expand TeleHealth acceptance that focus on patient selection and education. CLINICALTRIALS gov: NCT05084131.
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Affiliation(s)
- Catherine C Beauharnais
- University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Division of Colorectal Surgery, UMass Memorial Medical Center, Worcester, MA, USA.
| | - Susanna S Hill
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Paul R Sturrock
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Karim Alavi
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Justin A Maykel
- University of Massachusetts Chan Medical School, Worcester, MA, USA
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Like a Perfect Swiss Clock: Interactive and Multimodal Strategies to Improve Quality and Outcomes of Bariatric Surgery. Obes Surg 2022; 32:2797-2798. [DOI: 10.1007/s11695-022-06138-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
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Impact of Telehealth Implementation on an Adolescent Metabolic and Bariatric Surgery Program. Surg Obes Relat Dis 2022; 18:1161-1166. [DOI: 10.1016/j.soard.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/25/2022] [Accepted: 05/08/2022] [Indexed: 01/19/2023]
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Nijland L, Reiber B, Monpellier V, Jacobs A, Hazebroek E, van Veen R, Demirkiran A, de Castro S, Liem R, Swank D, Knook M, van Acker G, Tseng L, Marsman H, van Tets W, Cense H, Greve JW, Boerma EJ, Fransen S, de Witte E, Wiezer RM, Wijffels N, te Riele W, Derksen W, Takkenberg M, Aufenacker T, Vening W, Witteman B, den Hengst W. The association between patient attendance to a perioperative group-based lifestyle program and weight loss after bariatric surgery. Surg Obes Relat Dis 2022; 18:747-754. [DOI: 10.1016/j.soard.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/23/2022] [Accepted: 02/13/2022] [Indexed: 12/31/2022]
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Baldor D, Lewis PR, Tadlock MD. Routine in-person post-operative follow-up for uncomplicated laparoscopic appendectomy does not change management. Surg Endosc 2022; 36:3775-3780. [PMID: 34468847 PMCID: PMC8409267 DOI: 10.1007/s00464-021-08693-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Eliminating points in the continuum of care that do not change management is a safe strategy for cost containment and workflow efficiency in health systems. As a process improvement initiative, we sought to identify whether routine, outpatient follow-up changes management in laparoscopic appendectomy in a military hospital. METHODS We performed a retrospective chart review of adult patients undergoing laparoscopic appendectomy during a one-year period. The primary outcome was identification of a change in management during routine in person follow-up. Secondary outcomes included location of patient presentation with a post-operative event (clinic, emergency department, primary care provider), and if those visits changed management. Events were defined as any deviation from the typical post-operative course within 6 weeks of surgery, including abnormal specimen pathology. RESULTS One-hundred and seventy-six appendectomies were performed over one year, and 148 patients met inclusion criteria (median age = 27, 66.9% male). Perforation was identified in 10.1% of patients. Seventeen-point-five percent of patients had a post-operative event, of which persistent pain was the most common. Only 2.0% of all patients saw a change in management at their routine in person follow-up appointment. Eighty percent of patients with any post-operative events sought care outside of their routine in person follow up appointments. No variable was independently associated with a change in management. CONCLUSION Routine in-person clinical follow-up for laparoscopic appendectomy almost never changes management. Perforated appendicitis may be an indication for in-person follow-up. Considering a telemedicine model for post-operative follow-up of laparoscopic appendectomy patients will provide a safe and effective alternative to in-person clinic visits, while saving patients time and allowing providers the clinic freedom to prioritize more urgent and new patients.
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Affiliation(s)
- Daniel Baldor
- Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA, 92134, USA
| | - Paul R Lewis
- Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA, 92134, USA.
- Department of Surgery, Naval Medical Center San Diego, FPO AP 96362, 34800 Bob Wilson Dr., PSC 482 Box 2629, San Diego, CA, 92134, USA.
| | - Matthew D Tadlock
- Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA, 92134, USA
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Ferhatoglu MF, Kartal A, Filiz AI, Kebudi A. Outcome of Gastric Fundus and Pylorus Botulinum Toxin A Injection in Obese Patients Class I–II with Normal Pyloric Orifice Structure: A Retrospective Analysis. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Murat Ferhat Ferhatoglu
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | | | - Ali Ilker Filiz
- Department of General Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Abut Kebudi
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
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Sánchez Santos R, Garcia Ruiz de Gordejuela A, Breton Lesmes I, Lecube Torelló A, Moizé Arcone V, Arroyo Martin JJ, Fernandez Alsina E, Martín Antona E, Rubio Herrera MÁ, Sabench Pereferrer F, Sánchez Pernaute A, Vilallonga Puy R. Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity. Cir Esp 2021; 99:4-10. [PMID: 32921419 PMCID: PMC7301111 DOI: 10.1016/j.ciresp.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022]
Abstract
The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia.
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Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2021. [PMCID: PMC7836702 DOI: 10.1016/j.cireng.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia.
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Ferhatoglu MF, Kartal A, Filiz AI, Kebudi A. The Positive Effects of a Calorie-Restricting High-Protein Diet Combined with Intragastric Botulinum Toxin Type A Application Among Morbidly Obese Patients: A Prospective, Observational Analysis of Eighty-Seven Grade 2 Obese Patients. Obes Surg 2020; 30:3472-3479. [PMID: 32306298 DOI: 10.1007/s11695-020-04597-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Many studies evaluating the effect of intragastric botulinum toxin type A injection (IG-BTxA) for the treatment of obesity have been published. However, none of these studies combined this procedure with a calorie-restricting high-protein diet. Herein, we aimed to evaluate the effects of IG-BTxA application combined with a calorie-restricting high-protein diet. MATERIALS AND METHODS This prospective cohort study is conducted with eighty-seven grade 2 obese patients treated between January 2019 and August 2019. Group 1: IG-BTxA + refused to consult the dietitian; group 2: IG-BTxA + get calorie-restricting high-protein diet; group 3: only get a calorie-restricting high-protein diet. Loss of weight, treatment adaptation (visual analog scale score), the status and changes of comorbid conditions, and changes in eating behaviors (Self-Regulation of Eating Behaviour Questionnaire score) were assessed. RESULTS Loss of weight, treatment adaptation, and positive behavioral change in eating preferences were significantly higher in group 2 (p = 0.01; p = 0.001; p < 0.01, respectively). Additionally, the decrease in medication requirement for diabetes and hypertension was higher in group 2 (p < 0.05). CONCLUSION IG-BTxA application before calorie-restricting high-protein diet facilitates adaptation to the new diet style and helps to lose weight faster in grade 2 obese patients. Also, more positive results were achieved in terms of controlling comorbid diseases.
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Affiliation(s)
- Murat Ferhat Ferhatoglu
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Abdulcabbar Kartal
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey.
| | - Ali Ilker Filiz
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Abut Kebudi
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
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