[Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Baskıdaki Makaleler: TARD-70037

Perioperative Factors Affecting Ambulatory Outcomes Following Laparoscopic Adjustable Gastric Banding

Mirsad Dupanovic1, Ron Krebill2, Iris Dupanovic3, John Nachtigal1, Melissa Rockford1, Walter Orr1
1Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
2Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
3Tufts University, Boston, Massachusetts, USA

Objective: Morbidly obese patients are traditionally hospitalized following bariatric surgery. However, laparoscopic adjustable gastric banding (LAGB) is amenable for ambulatory care. We hypothesized that the majority of patients can receive an ambulatory LAGB and that both surgical and anesthetic perioperative factors will significantly affect non-ambulatory LAGB
Methods: Medical records of 201 consecutive LAGB patients performed at the University of Kansas Medical Center during a three-year period were reviewed. Demographic, medical, laboratory, anesthetic, intraoperative, and postoperative data were collected. Factors associated with non-ambulatory outcomes were identified and analyzed using logistic regression, and a classification tree analysis was used to rank the descriptive model factor to the non-ambulatory outcome.
Results: Average patient age was 43.4 + 11.4 years and average BMI was 48.2 + 10.3. 155 patients (77.1%; 95% CI 71-83%; p <.0001) were discharged home within 2-3 hours of surgery, while 36 stayed for 23 hours and 10 required hospital admission for 1-2 days. Increased surgical port numbers (p=0.007), ≥[?]50% of total intraoperative fentanyl administered in the recovery room (PACU) for treatment of postoperative pain (p=0.007), and a lack of prophylactic beta blockade (p=0.001) were three factors associated with non-ambulatory outcomes. Obstructive sleep apnea was not associated with a non-ambulatory outcome (p=0.83).
Conclusion: The majority of patients received an ambulatory LAGB. Meticulous laparoscopic surgical technique with the least feasible number of access ports and multimodal analgesic technique aimed at reduction of postoperative opioid consumption are the most important factors for a successful ambulatory LAGB outcome.

Keywords: Ambulatory surgery, outpatient surgery, laparoscopic surgery, bariatric surgery

Sorumlu Yazar: Mirsad Dupanovic, United States

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