2000 Fast Track Laparoscopic Bypass Procedures - PowerPoint PPT Presentation

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    1. IFSO 2010

    2. IFSO 2010

    3. IFSO 2010 Private Hospital Mlholm 25 specialities 30 beds 4.500 operations in general anesthesia per year

    4. IFSO 2010 Bariatic Program Private Hospital Mlholm Preoperative group education Multidisciplinary evaluation Preoperative treatment, 8% - 10 %weight loss, 2-4 months Operation, one day stay Follow-up and documentation 1,4,12 months,incl. Moorehead questionnaire 2, 3,4,5..10 years

    5. IFSO 2010 Preoperative group education Patients and relatives Preoperative education Individual evaluation Endocrinologist Surgeon Dietician Interaction with patients who have undergone bariatic surgery

    6. IFSO 2010 In-hospital approach Admission 2 hours before surgery Low-molecular-weight heparin 5000 four hour postop. Antibiotics peroperatively Cefuroxim 1.5 g Metronidazol 1 g

    7. IFSO 2010 Surgery Staff One surgeon Two dedicated scrub nurses Linear Stapled Double Loop Technique No drainage No tubes

    8. IFSO 2010 Postoperative management Recovering at the ward Monitoring pulsoximetry, telemetry, peripheral arterial catheters Early mobilization, 2 hours postop Immediate oral intake Fluid Soup

    9. IFSO 2010 Discharge teaching Discharge 1. postoperative day before 11 a.m Oral and written information Postoperative medication Symptoms and signs of early and late complications Dietary information Wound care Physical activity Follow-up Contact information, emergent and nonemergent call

    10. IFSO 2010 Bariatic Surgery Private Hospital Molholm First operation 1. January 2006 > 3000 procedures 99% lap. bypass 1. January 2007 introduced fast track one day stay 1. August 2007 propective registration: In hospital stay Time of leaving to operation room Time of return to ward Time of mobilization Time of discharge In-hospital complications Patient self assessement Operation Operative time Peroperative complications Follow up 1, 4 and 12 months and yearly questionare and blodtest Re-admission, complications , satisfaction, QoL Validation of follow-up data by checking for readmission in the danish registry of

    11. IFSO 2010 Validation of follow-up data All patiens operated and discharged from Privatehospitale Molholm was checked for readmissions in the Danish Register for Patients ICD, procedure code, and time for readmission was recorded and compared with our data

    12. IFSO 2010 Laparoscopic Gastric Bypass Hospital Mlholm

    13. IFSO 2010 Material prospective consecutive Laparoscopic Bypass, fast track Periode 01.08.2007-06.03.2010

    14. IFSO 2010 Operative time time skin incision skin closure, minutes

    15. IFSO 2010 Time returning to ward and mobilization

    16. IFSO 2010 Discharge

    17. IFSO 2010 Patient assessment, N= 2000 Time of discharge

    18. IFSO 2010 Patient Assessment, N = 2000 In-hospital stay

    19. IFSO 2010 Perioperative complications In-hospital, re-operation

    20. IFSO 2010 Complications within 4 months Re-admission after discharge

    21. IFSO 2010 Quality of Life Moorehead Questionnaire

    22. IFSO 2010 Conclusion Laparoscopic Fast Track Gastric By-pass Feasible Low in-hospital reoperation rate Low re-admission rate Low mortality High patient satisfaction