Torgeir T Søvik1, Erlend T Aasheim2,3, Jon Kristinsson4, Carl Fredrik Schou4, Lien My Diep5, Arild Nesbakken2, Tom Mala4. 1. Faculty of Medicine, University of Oslo, Oslo, Norway. torgeir.sovik@akersykehus.no. 2. Faculty of Medicine, University of Oslo, Oslo, Norway. 3. Department of Medicine, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway. 4. Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway. 5. Aker University Hospital Research Center, Trondheimsveien 235, 0514, Oslo, Norway.
Abstract
BACKGROUND: Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: Morbidly obese patients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons. RESULTS: The 292 included patients had a mean age of 40.0 +/- 9.5 years and a mean body mass index (BMI) of 46.7 +/- 5.3 kg/m(2). The mean length of surgery was 101 +/- 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1-77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found. CONCLUSION: LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.
BACKGROUND: Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: Morbidly obesepatients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons. RESULTS: The 292 included patients had a mean age of 40.0 +/- 9.5 years and a mean body mass index (BMI) of 46.7 +/- 5.3 kg/m(2). The mean length of surgery was 101 +/- 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1-77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found. CONCLUSION: LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.
Authors: Lars Sjöström; Anna-Karin Lindroos; Markku Peltonen; Jarl Torgerson; Claude Bouchard; Björn Carlsson; Sven Dahlgren; Bo Larsson; Kristina Narbro; Carl David Sjöström; Marianne Sullivan; Hans Wedel Journal: N Engl J Med Date: 2004-12-23 Impact factor: 91.245
Authors: Torgeir T Søvik; Erlend T Aasheim; Jon Kristinsson; Carl Fredrik Schou; Arild Nesbakken; Tom Mala Journal: Tidsskr Nor Laegeforen Date: 2007-01-04
Authors: Cynthia L Ogden; Margaret D Carroll; Lester R Curtin; Margaret A McDowell; Carolyn J Tabak; Katherine M Flegal Journal: JAMA Date: 2006-04-05 Impact factor: 56.272
Authors: Christopher G Andrew; Wael Hanna; Didier Look; Alexander P H McLean; Nicolas V Christou Journal: Can J Surg Date: 2006-12 Impact factor: 2.089
Authors: Aldo L Brasileiro; Fausto Miranda; João E M T M Ettinger; Aldemar A Castro; Guilherme B B Pitta; Liberato K de Moura; Euler Azaro; Marcelo L de Moura; Carlos A B Mello; Edvaldo Fahel; Luiz F P de Figueiredo Journal: Obes Surg Date: 2007-12-15 Impact factor: 4.129
Authors: Kian A Modanlou; Umadevi Muthyala; Huiling Xiao; Mark A Schnitzler; Paolo R Salvalaggio; Daniel C Brennan; Kevin C Abbott; Ralph J Graff; Krista L Lentine Journal: Transplantation Date: 2009-04-27 Impact factor: 4.939
Authors: Hugo Meunier; Yannick Le Roux; Anne-Lise Fiant; Yoann Marion; Adrien Lee Bion; Thomas Gautier; Nicolas Contival; Jean Lubrano; Fabienne Fobe; Marion Zamparini; Marie-Astrid Piquet; Véronique Savey; Arnaud Alves; Benjamin Menahem Journal: Obes Surg Date: 2019-09 Impact factor: 4.129
Authors: F S Wehrtmann; J R de la Garza; K F Kowalewski; M W Schmidt; K Müller; C Tapking; P Probst; M K Diener; L Fischer; B P Müller-Stich; F Nickel Journal: Obes Surg Date: 2020-02 Impact factor: 4.129
Authors: Kemal Dogan; Linda Kraaij; Edo O Aarts; Parweez Koehestanie; Edwin Hammink; Cees J H M van Laarhoven; Theo J Aufenacker; Ignace M C Janssen; Frits J Berends Journal: Obes Surg Date: 2015-01 Impact factor: 4.129