title: Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care.
abstract: BACKGROUND
  Due to the increased incidence of morbid obesity, the demand for bariatric surgery is increasing. Therefore, the methods for optimising perioperative care for the improvement of surgical outcome and to increase efficacy are necessary. The aim of this prospective matched cohort study is to objectify the effect of the fast-track surgery (FTS) programme in patients undergoing primary Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) surgery compared to conventional perioperative care (CPC).
  
  
  METHODS
  This study compared the perioperative outcome data of two groups of 75 consecutive morbid obese patients who underwent a primary LRYGB according to international guidelines in the periods January 2011-April 2011 (CPC group) and April 2012-June 2012 (FTS group). The two groups were matched for age and sex. Primary endpoints were surgery and hospitalisation time, while secondary endpoints were intraoperative medication use and complication rates.
  
  
  RESULTS
  Baseline patient characteristics for age, sex, weight and ASA classification were similar (p > 0.05) for CPC and FTS patients. BMI and waist circumference were significantly lower (p < 0.05) in the FTS compared to CPC. The total time from arrival at the operating room to the arrival at the recovery was reduced from 119 to 82 min (p < 0.001). Surgery time was reduced from 80 to 56 min (p < 0.001); mean hospital stay was reduced from 65 to 43 h (p < 0.001). Major complications occurred in 3 versus 4 % in the FTS and CPC, respectively.
  
  
  CONCLUSIONS
  The introduction of a fast-track programme after primary LRYGB improves short-term recovery and may reduces direct hospital-related resources.
authors.affiliation: Department of Surgery, Rijnstate Hospital Arnhem, Intern post number 1190, Post Box 9555, 6800 TA, Arnhem, The Netherlands, dogan_kemal@hotmail.com.
authors.forename: Kemal
authors.initials: K
authors.lastname: Dogan
authors.forename: Linda
authors.initials: L
authors.lastname: Kraaij
authors.forename: Edo O
authors.initials: EO
authors.lastname: Aarts
authors.forename: Parweez
authors.initials: P
authors.lastname: Koehestanie
authors.forename: Edwin
authors.initials: E
authors.lastname: Hammink
authors.forename: Cees J H M
authors.initials: CJ
authors.lastname: van Laarhoven
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Aufenacker
authors.forename: Ignace M C
authors.initials: IM
authors.lastname: Janssen
authors.forename: Frits J
authors.initials: FJ
authors.lastname: Berends
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods* / Q000534:rehabilitation; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000534:rehabilitation; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D010348:Patient Care Team / Q000458:organization & administration*; D019990:Perioperative Care / Q000379:methods*; D059039:Standard of Care / Q000458:organization & administration*; D016896:Treatment Outcome; D055105:Waist Circumference