title: Anesthesia for bariatric surgery: 8-year retrospective study: are our patients now easier to manage?
abstract: OBJECTIVE
  To review the perioperative management of patients who had undergone bariatric surgery in our institution during an 8-year period, with the aim of identifying variables that correlated with improved clinical outcomes and changes in perioperative practice.
  
  
  METHODS
  This was a retrospective observational study of 437 patients who had undergone bariatric surgery from January 2005 to June 2013. Of these patients, 163 had undergone open or laparoscopic biliopancreatic diversion (Group 1), and 274 had been managed according to a Tailored Laparoscopic Approach Program (TLAP) (Group 2). We analyzed major cardiocirculatory, pulmonary, and surgery-related complications, mortality rate, intensive care unit (ICU) admissions, post-anesthetic care unit (PACU) length of stay, and perioperative management standards, throughout the study period.
  
  
  RESULTS
  Changes were observed in anesthetic patterns and perioperative care standards during the study period: 25% of patients had combined epidural anesthesia in 2005, compared with none at present; ICU admissions decreased from 28.6% in 2005 to 3.1% at present; and time in PACU declined from a median of 23 h in 2005 to 5.12h at present. Duration of postoperative opioid therapy was also significantly reduced (from 48 h to 6h). Group 2 had a significantly lower mortality rate than Group 1 (0.37% versus 4.3%, respectively, P=0.004).
  
  
  CONCLUSIONS
  In our institution, adoption of a TLAP for bariatric surgery has led to changes in perioperative care standards that have been followed by clear improvements according to morbidity, mortality and management indicators.
authors.affiliation: Unidad de Gestión Clínica del Bloque Quirúrgico, Hospital General, Hospital Universitario, Virgen del Rocío, Sevilla, Spain. Electronic address: mdlmattam@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: de la Matta-Martín
authors.affiliation: Unidad de Gestión Clínica del Bloque Quirúrgico, Hospital General, Hospital Universitario, Virgen del Rocío, Sevilla, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Acosta-Martínez
authors.affiliation: Unidad de Gestión Clínica del Bloque Quirúrgico, Hospital General, Hospital Universitario, Virgen del Rocío, Sevilla, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Sánchez-Carrillo
mesh_terms: D000698:Analgesia / Q000379:methods; D000768:Anesthesia, General / Q000379:methods* / Q000639:trends; D050110:Bariatric Surgery / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D015904:Biliopancreatic Diversion / Q000706:statistics & numerical data; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D010149:Postoperative Pain / Q000628:therapy; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies
keywords: Bariatric surgery; Cirugía bariátrica; Duración de la estancia; Laparoscopia; Laparoscopy; Length of stay; Morbidity, mortality; Morbimortalidad; Perioperative management; Tratamiento perioperatorio