Outpatient Bariatric Surgery
Condition: Obesity, Morbid
MeSH terms: Obesity, Morbid
Study type: Interventional

Summary: 
      This study first presents the organizational path and the health interventions included in
      the care episode for outpatient bariatric surgery, as compared to the health interventions
      usually performed in the care episode for bariatric surgery (including a conventional
      hospitalization with at least one-night inpatient). Then, the study aims to estimate and to
      compare the costs of bariatric surgery inpatient care episode to the costs of outpatient care
      episode, and also to evaluate the postoperative medical consequences.
    

Detailed description: 
      This study first presents the organizational path and the health interventions included in
      the care episode for outpatient bariatric surgery, as compared to the health interventions
      usually performed in the care episode for bariatric surgery (including a conventional
      hospitalization with at least one-night inpatient).

      This single-center, matched case-control study will be conducted in the Endocrine and
      Digestive Surgery Unit, Center of Excellence in Bariatric Surgery, of the University Hospital
      of Strasbourg. All the patients scheduled for bariatric procedures (Roux-en-Y gastric bypass
      and Sleeve Gastrectomy) and eligible for outpatient ambulatory procedures, will be checked
      for the inclusion criteria and will be asked if they accepted the outpatient bariatric
      procedure. If they accept, they will be included in the group A ("Outpatients"). At the end
      of the inclusion period, the patients in group A will be paired to patients who were operated
      in the same period, who had a conventional hospitalization and who will be matched based on
      the type of intervention, the age and the ASA status. These patients will form the group B
      ("Inpatients").

      The integrated care pathway of the outpatients was formalized in order to secure this care
      pathway. It includes: patient education, enhanced rehabilitation program, first-position
      surgical planning, follow-up by home nurse twice-a-day, standardized communication to
      surgeons, and management of possible complications. All the health care interventions
      (anticipated or not) will be recorded for both groups.

      The study aims to estimate and to compare the costs of bariatric surgery inpatient care
      episode to the costs of outpatient care episode, and also to evaluate the postoperative
      medical consequences. A cost-minimization analysis will be performed from the perspective of
      the healthcare provider. The direct costs of care production will be considered and estimated
      by a micro-costing methodology. The time horizon is set from the pre-operative outpatient
      appointment with the bariatric surgeon to the one-month post-operative appointment.
    

Intervention name(s): Outpatient health care pathway
Intervention type(s): Other
Intervention description(s): A surgical procedure performed as an outpatient procedure means that the patient leaves the hospital before 8pm the same day. The surgery is identical but the standard care pathway is reinforced to insure a safe return to home.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Severe Obesity; Outpatient Surgery; Bariatric Surgery; Roux-en-Y Gastric Bypass; Sleeve Gastrectomy