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Making lemonade with lemons: a multicenter effort to improve outpatient sleeve gastrectomy amid the COVID-19 pandemic. | LitMetric

AI Article Synopsis

  • - The COVID-19 pandemic prompted a quality initiative to improve outpatient sleeve gastrectomy workflows and lessen the burden on hospitals, leading to a study analyzing patient outcomes from February 2020 to August 2021.
  • - The study found significant differences in demographics and postoperative outcomes between outpatient (427 patients) and inpatient (211 patients) cohorts, with a higher incidence of emergency department readmissions in the inpatient group.
  • - Results suggest that outpatient sleeve gastrectomy is both safe and effective, with certain risk factors for inpatient admission identified, highlighting the importance of administrative support for implementing this procedure across healthcare systems.

Article Abstract

Background: The COVID-19 pandemic impacted healthcare delivery worldwide. Resource limitations prompted a multicenter quality initiative to enhance outpatient sleeve gastrectomy workflow and reduce the inpatient hospital burden.

Objectives: This study aimed to determine the efficacy of this initiative, as well as the safety of outpatient sleeve gastrectomy and potential risk factors for inpatient admission.

Setting: A retrospective analysis of sleeve gastrectomy patients was conducted from February 2020 to August 2021.

Methods: Inclusion criteria were adult patients discharged on postoperative day 0, 1, or 2. Exclusion criteria were body mass index ≥60 kg/m and age ≥65 years. Patients were divided into outpatient and inpatient cohorts. Demographic, operative, and postoperative variables were compared, as well as monthly trends in outpatient versus inpatient admission. Potential risk factors for inpatient admission were assessed, as well as early Clavien-Dindo complications.

Results: Analysis included 638 sleeve gastrectomy surgeries (427 outpatient, 211 inpatient). Significant differences between cohorts were age, co-morbidities, surgery date, facility, operative duration, and 30-day emergency department (ED) readmission. Monthly frequency of outpatient sleeve gastrectomy rose as high as 71% regionally. An increased number of 30-day ED readmissions was found for the inpatient cohort (P = .022). Potential risk factors for inpatient admission included age, diabetes, hypertension, obstructive sleep apnea, pre-COVID-19 surgery date, and operative duration.

Conclusion: Outpatient sleeve gastrectomy is safe and efficacious. Administrative support for extended postanesthesia care unit recovery was critical to successful protocol implementation for outpatient sleeve gastrectomy within this large multicenter healthcare system, demonstrating potential applicability nationwide.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9896885PMC
http://dx.doi.org/10.1016/j.soard.2023.01.022DOI Listing

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