Fast-Track in Bariatric and Metabolic Surgery: Feasibility and Cost Analysis Through a Matched-Cohort Study in a Single Centre.

Abstract

Due to the rise in severe obesity in Western countries and the increase in bariatric surgery, enhanced recovery (ER) pathways should be developed and promoted. A monocentric prospective series of 103 bariatric surgery patients managed with the ER pathway (group ER) was compared with a retrospective and immediately previous series of 103 patients managed with standard care (group CS). The aim of the present study was to assess and compare the differences in terms of mean postoperative length of stay (LOS), costs for surgery and recovery, and the differences in terms of complications, readmission, and reoperation rate in the short term between the ER and CS groups. The mean LOS was 4.18days in group CS and 1.79days in group ER (p<0.0001). The mean operative time (OT) per patient was 190.20min in the group CS and 133.54min in the group ER, resulting in an average cost of 7272.57€ per patient in group CS and 5424.09€ per patient in group ER. The average recovery cost was 1809.94€ for the group CS series and 775.07 for the group ER one. Overall complications (Clavien-Dindo up to II) occurred in 6 patients (5.8%) in group CS and in 2 patients (1.9%) in group ER (p=0.149) and specific complications (Clavien-Dindo IIIb) occurred for 9 patients (8.7%) in Group CS and for 14 patients (13.5%) in group ER (p=0.268) after hospital discharge within 1-month of follow-up. Twelve patients (11.5%) in group CS and 13 (12.5%) in group ER were readmitted after discharge (p=0.831) within 1-month of follow-up; 8 patients (7.7%) in group CS versus 9 patients (8.8%) in group ER needed to be reoperated (p=0.800) within 1-month follow-up. Enhanced recovery pathway reduces significantly LOS in bariatric surgical patients and shortens the mean OT of the procedure, with no significant differences in terms of surgical outcomes. Furthermore, recovery charges were lower and operative time was shorter allowing for procedural cost reduction.