High-Volume Bariatric Surgery in a Single Center: Safety, Quality, Cost-Efficacy and Teaching Aspects in 2,000 Consecutive Cases
- 25 November 2011
- journal article
- Published by Springer Science and Business Media LLC in Obesity Surgery
- Vol. 22 (1), 158-166
- https://doi.org/10.1007/s11695-011-0557-0
Abstract
Obesity surgery is the most effective treatment for morbid obesity and the fastest growing area in surgery. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard procedure in many countries. Optimization of the treatment process is important in order to keep the morbidity rate down and cost of treatment as low as possible. In September 2005, we established a bariatric surgery program. Until December 2010, 2,000 patients underwent LRYGB. Clinical pathways were established, with focus on safety, fast-track methodology and training of surgeons. Time recordings from all parts of the treatment, as well as clinical outcome, were prospectively registered. Time consumption for the total procedure in the operating theater was reduced from 102 to 54 min (P < 0.001). With only 11 min turnover between patients, the total time for one patient has been reduced to 65 min, enabling us to perform six operations in a single operating theater during ordinary daytime. Early complication rate was 2.8%, and mean hospital stay was 2.3 days. We were able to double the patients treated in 2010 compared to 2007 with only 10% increase in staff. Three surgeons were trained during the period into fully qualified senior bariatric surgeons. Multimodal evidence-based care within the fast-track methodology and routine time recordings was successful in order to increase the production volumes and reduce costs, without compromising the safety or quality for the patients. This kind of approach may be transferred to other types of standardized surgery.Keywords
This publication has 21 references indexed in Scilit:
- Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypassSurgical Endoscopy, 2009
- Fast‐track surgery for bariatric laparoscopic gastric bypass with focus on anaesthesia and peri‐operative care. Experience with 500 casesActa Anaesthesiologica Scandinavica, 2008
- Laparoscopic vs Open Gastric Bypass in the Management of Morbid Obesity: A 7-year Retrospective Study of 1,364 Patients from a Single CenterObesity Surgery, 2008
- Relationship of Processes and Structures of Care in General Surgery to Postoperative Outcomes: A Descriptive AnalysisJournal of the American College of Surgeons, 2007
- Financial Impact of Obesity and Bariatric SurgeryMedical Clinics of North America, 2007
- A systematic review of the impact of volume of surgery and specialization on patient outcomeBritish Journal of Surgery, 2007
- Operative Mortality and Procedure Volume as Predictors of Subsequent Hospital PerformanceAnnals of Surgery, 2006
- Leveling the learning curve for laparoscopic bariatric surgerySurgical Endoscopy, 2005
- The Learning Curve Measured by Operating Times for Laparoscopic and Open Gastric Bypass: Roles of Surgeon's Experience, Institutional Experience, Body Mass Index and Fellowship TrainingObesity Surgery, 2005
- Laparoscopic Roux-en-Y Gastric Bypass with 2-metre Long Biliopancreatic Limb for Morbid Obesity: Technique and Experience with the First 150 PatientsObesity Surgery, 2005