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- Title
The Effect of Clinical Pathways for Bariatric Surgery on Perioperative Quality of Care.
- Authors
Ronellenfitsch, Ulrich; Schwarzbach, Matthias; Kring, Anne; Kienle, Peter; Post, Stefan; Hasenberg, Till
- Abstract
Background: Bariatric surgery demands a multidisciplinary approach and enhanced recovery schemes. Such schemes are complex and cumbersome to introduce into practice. This study evaluates if a clinical pathway (CP) facilitates implementation of an enhanced recovery scheme in bariatric surgery with the goal of improving perioperative quality of care. Methods: We compared 65 consecutive patients who underwent bariatric surgery in 2009 and were treated with a CP (CP group) with 64 consecutive patients treated without CP in 2007/2008 (pre-CP group). Process quality indicators were catheter management, postoperative mobilization, spirometer training, vitamin B supplementation, diet resumption, intake of supplement drinks, and length of stay. Outcome quality was measured through morbidity, mortality, re-operations, and re-admissions. Results: In the CP group, foley catheters were removed earlier ( p < 0.0001), patients were mobilized more often on the surgery day (CP group 92.3% vs. pre-CP group 78.1%, p = 0.03), used spirometers more often (56.9% vs. 28.1%, p = 0.002), were more often supplemented with vitamin B (100% vs. 31.3%, p < 0.0001), and received oral supplement nutrition more often (100% vs. 59.4%, p < 0.0001). Median length of stay was shorter in the CP group (6 vs. 7 days, p = 0.007). There was no significant difference in mortality, morbidity, re-operations, and re-admissions. Conclusions: Following implementation of an enhanced recovery CP for bariatric surgery, several indicators of process quality improved while outcome quality remained unchanged. A CP seems useful for optimizing treatment of bariatric surgery patients according to enhanced recovery principles. However, future studies are required to better determine which elements of care can be improved most.
- Subjects
BARIATRIC surgery; MEDICAL quality control; CATHETERS; POSTOPERATIVE care; SPIROMETRY
- Publication
Obesity Surgery, 2012, Vol 22, Issue 5, p732
- ISSN
0960-8923
- Publication type
Article
- DOI
10.1007/s11695-012-0605-4