title: High-volume bariatric surgery in a single center: safety, quality, cost-efficacy and teaching aspects in 2,000 consecutive cases.
abstract: BACKGROUND
  Obesity surgery is the most effective treatment for morbid obesity and the fastest growing area in surgery. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard procedure in many countries. Optimization of the treatment process is important in order to keep the morbidity rate down and cost of treatment as low as possible.
  
  
  METHODS
  In September 2005, we established a bariatric surgery program. Until December 2010, 2,000 patients underwent LRYGB. Clinical pathways were established, with focus on safety, fast-track methodology and training of surgeons. Time recordings from all parts of the treatment, as well as clinical outcome, were prospectively registered.
  
  
  RESULTS
  Time consumption for the total procedure in the operating theater was reduced from 102 to 54 min (P < 0.001). With only 11 min turnover between patients, the total time for one patient has been reduced to 65 min, enabling us to perform six operations in a single operating theater during ordinary daytime. Early complication rate was 2.8%, and mean hospital stay was 2.3 days. We were able to double the patients treated in 2010 compared to 2007 with only 10% increase in staff. Three surgeons were trained during the period into fully qualified senior bariatric surgeons.
  
  
  CONCLUSIONS
  Multimodal evidence-based care within the fast-track methodology and routine time recordings was successful in order to increase the production volumes and reduce costs, without compromising the safety or quality for the patients. This kind of approach may be transferred to other types of standardized surgery.
authors: Department of Surgery and Anesthesia, Aleris Hospital, Fredrik-Stangsgt 11-13, 0264 Oslo, Norway. hedinjac@online.no
authors: H J
authors: HJ
authors: Jacobsen
authors: A
authors: A
authors: Bergland
authors: J
authors: J
authors: Raeder
authors: H G
authors: HG
authors: Gislason
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D055317:Evidence-Based Practice; D005260:Female; D015390:Gastric Bypass / Q000191:economics / Q000193:education / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D009767:Obesity, Morbid / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D011182:Postoperative Care / Q000191:economics / Q000592:standards*; D011300:Preoperative Care / Q000191:economics / Q000592:standards*; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome; D055815:Young Adult