title: Fast track care for gastric bypass patients decreases length of stay without increasing complications in an unselected patient cohort.
abstract: BACKGROUND
  Retrospective studies investigating fast track care involve selected patients. This study evaluates the implementation of fast track care in unselected bariatric patients in a high volume teaching hospital in the Netherlands.
  
  
  METHODS
  Consecutive patients who underwent a primary laparoscopic gastric bypass in our center were reviewed in the years before (n = 104) and after implementation of fast track care (n = 360). Fast track involved the banning of tubes/catheters, anesthetic management and early ambulation. Primary outcome was the length of stay. Perioperative times, complications (<30 days), readmissions and prolonged length of stay were secondary outcomes.
  
  
  RESULTS
  The median length decreased after implementation of fast track (3 days versus 1 day, p < 0.001). Overall complication rate remained stable after implementation of fast track care (17.3 % versus 18.3 %, not significant). Readmission rate did not differ between groups (4.8 % conventional care versus 8.1 % fast track, not significant). More grades I-IVa complications occurred outside the hospital after the implementation of fast track care (24.8 % versus 51.5 %). Lower age (b = 0.118, 95 % CI: 0.002-0.049, p < 0.05) and the implementation of fast track (b = -0.270, 95 % CI: -1.969 to -0.832, p < 0.001) were the only factors that significantly shortened the length of stay.
  
  
  CONCLUSIONS
  Patients that received fast track care had a decreased length of stay. Although more complications occurred after discharge in the fast track care group, this did not lead to adverse outcomes. Fast track does enhance recovery and is suitable for unselected patients. Care providers should select their patients for early discharge and pursue a low threshold for readmission.
authors.affiliation: Department of Metabolic and Bariatric Surgery, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands, ngeubbels@gmail.com.
authors.forename: Noëlle
authors.initials: N
authors.lastname: Geubbels
authors.forename: Sjoerd C
authors.initials: SC
authors.lastname: Bruin
authors.forename: Yair I Z
authors.initials: YI
authors.lastname: Acherman
authors.forename: Arnold W J M
authors.initials: AW
authors.lastname: van de Laar
authors.forename: Marijke B
authors.initials: MB
authors.lastname: Hoen
authors.forename: L Maurits
authors.initials: LM
authors.lastname: de Brauw
mesh_terms: D000328:Adult; D004434:Early Ambulation; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D018579:Patient Selection; D012189:Retrospective Studies