Background

The COVID-19 pandemic created delays in surgical care. The population with obesity has a high risk of death from COVID-19. Prior literature shows the most effective way to combat obesity is by weight loss surgery. At different times throughout the COVID-19 pandemic, elective inpatient surgeries have been halted due to bed availability. Recognizing that major complications following bariatric surgery are extremely low (bleeding 0–4%, anastomotic leaks 0.8%), we felt outpatient bariatric surgery would be safe for low-risk patients. Complications such as DVT, PE, infection, and anastomotic leaks typically present after 7 days postoperatively, well outside the usual length of stay. Bleeding events, severe postoperative nausea, and dehydration typically occur in the first few days postoperatively. We designed a pathway focused on detecting and preventing these early post-op complications to allow safe outpatient bariatric surgery.

Methods

We used a preoperative evaluation tool to risk stratify bariatric patients. During a 16-month period, 89 patients were identified as low risk for outpatient surgery. We designed a postoperative protocol that included IV hydration and PO intake goals to meet a safe discharge. We sent patients home with a pulse oximeter and had them self-monitor their pulse and oxygen saturation. We called all patients at 10 pm for a postoperative assessment and report of their vitals. Patients returned to clinic the following day and were seen by a provider, received IV hydration, and labs were drawn. RESULTS: 80 of 89 patients (89.8%) were successfully discharged on POD 0. 3 patients were readmitted within 30 days. We had zero deaths in our study cohort and no morbidity that would have been prevented with postoperative admission.

Conclusion

We demonstrate that by identifying low-risk patients for outpatient bariatric surgery and by implementing remote monitoring of vitals early outpatient follow-up, we were able to safely perform outpatient bariatric surgery.

Graphical abstract

中文翻译：

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在 COVID-19 大流行期间抗击肥胖大流行

背景

COVID-19 大流行导致外科治疗延误。肥胖人群死于 COVID-19 的风险很高。先前的文献表明，对抗肥胖最有效的方法是通过减肥手术。在整个 COVID-19 大流行期间的不同时间，选择性住院手术因床位供应而停止。认识到减肥手术后的主要并发症极低（出血 0–4%，吻合口漏 0.8%），我们认为门诊减肥手术对低风险患者是安全的。DVT、PE、感染和吻合口漏等并发症通常在术后 7 天后出现，远远超出通常的住院时间。出血事件、严重的术后恶心和脱水通常发生在术后的最初几天。

方法

我们使用术前评估工具对肥胖患者进行风险分层。在 16 个月的时间里，89 名患者被确定为门诊手术的低风险患者。我们设计了一个术后方案，其中包括 IV 水化和 PO 摄入量目标，以满足安全出院。我们让患者带着脉搏血氧计回家，让他们自我监测脉搏和血氧饱和度。我们在晚上 10 点召集所有患者进行术后评估并报告他们的生命体征。患者第二天返回诊所，由提供者会诊，接受静脉补液，并进行实验室检查。结果：89 名患者中有 80 名 (89.8%) 在 POD 0 时成功出院。3 名患者在 30 天内再次入院。在我们的研究队列中，我们的死亡率为零，并且没有发生术后入院可以预防的发病率。

结论

我们证明，通过识别门诊减肥手术的低风险患者，并通过实施远程生命体征早期门诊随访，我们能够安全地进行门诊减肥手术。

图形概要