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      Perioperative Factors Affecting Ambulatory Outcomes Following Laparoscopic-Adjustable Gastric Banding Translated title: Laparoskopik-Ayarlanabilir Gastrik Band Ameliyatı Sonrası Ambulatuvar Sonuca Etki Eden Perioperatif Faktörler

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          Abstract

          Objective

          Morbidly obese patients are traditionally hospitalised following bariatric surgery. However, laparoscopic-adjustable gastric banding (LAGB) is amenable for ambulatory care. We hypothesised that the majority of patients can receive an ambulatory LAGB and that both surgical and anaesthetic perioperative factors will significantly affect non-ambulatory LAGB outcomes.

          Methods

          Medical records of 201 consecutive LAGB patients performed at the University of Kansas Medical Centre during a 3-y period were reviewed. Demographic, medical, laboratory, anaesthetic, intraoperative and postoperative data were collected. Factors associated with non-ambulatory outcomes were identified and analysed using logistic regression, and a classification tree analysis was used to rank the descriptive model factor to the non-ambulatory outcome.

          Results

          Average patient age was 43.4±11.4 years, and average body mass index was 48.2±10.3 kg m 2–1. A total of 155 patients (77.1%; 95% confidence interval, 71%–83%; p<0.0001) were discharged home within 2–3 hours of surgery, whereas 36 stayed for 23 hours and 10 required hospital admission for 1–2 days. Increased surgical port numbers (p=0.007), ≥50% of total intraoperative fentanyl administered in the recovery room (post-anaesthesia care unit) for the treatment of postoperative pain (p=0.007) and a lack of prophylactic beta-blockade (p=0.001) were three factors associated with non-ambulatory outcomes. Obstructive sleep apnoea was not associated with a non-ambulatory outcome (p=0.83).

          Conclusion

          The majority of patients received an ambulatory LAGB. Meticulous laparoscopic surgical technique with the least feasible number of access ports and multimodal analgesic technique aimed at reduction of postoperative opioid consumption are the most important factors for a successful ambulatory LAGB outcome.

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          Author and article information

          Journal
          Turk J Anaesthesiol Reanim
          Turk J Anaesthesiol Reanim
          Turkish Journal of Anaesthesiology and Reanimation
          Turkish Anaesthesiology and Intensive Care Society
          2149-0937
          2149-276X
          October 2017
          28 August 2017
          : 45
          : 5
          : 282-288
          Affiliations
          [1 ]Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
          [2 ]Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
          [3 ]Tufts University, Boston, Massachusetts, USA
          Author notes
          Address for Correspondence: Mirsad Dupanovic, E-mail: mdupanovic@ 123456kumc.edu
          Article
          PMC5656163 PMC5656163 5656163 tard-45-5-282
          10.5152/TJAR.2017.70037
          5656163
          29114413
          01a0a7d8-7df4-424f-af3c-5a4efdae30f7
          © Copyright 2017 by Turkish Anaesthesiology and Intensive Care Society
          History
          : 09 November 2016
          : 06 April 2017
          Categories
          Original Article

          laparoscopic surgery,bariatric surgery,Ambulatory surgery,outpatient surgery

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