Development of consensus-derived quality indicators for laparoscopic sleeve gastrectomy operative reports.

BACKGROUND: Synoptic operative reporting has been used as a solution to the poor quality of narrative reports. The aim of this study was to develop operative report quality indicators for the laparoscopic sleeve gastrectomy and to generate parameters by which these reports can be evaluated and improved. METHODS: A Delphi protocol was used to determine quality indicators for LSG. Bariatric surgeons across Canada were recruited along with key physician stakeholders to participate via a secure web-based platform. Transferrable consensus items for LSG from previously developed Roux-en-Y gastric bypass operative indictors were put forward for consideration. Participants also initially submitted potential QIs. These were grouped by theme. Items were rated on 5-point Likert scales in subsequent rounds. Scores of 70% or higher were used for inclusion and 30% or less denoted exclusion. Elements scoring 30% to 70% agreement were recirculated by runoff in subsequent rounds to generate the final list of quality indicators. RESULTS: Seven bariatric surgeons, representing all regions preforming LSG in Canada, were invited to participate in the Delphi group. Multidisciplinary invitees included one academic minimally invasive/acute care surgeon, one tertiary abdominal radiologist, and one academic gastroenterologist with bariatric expertise. Two rounds were required to achieve consensus. Both rounds achieved a 100% response (10/10). In round 1, forty items reached consensus. In Round 2, an additional 28 items reached consensus, with three items excluded, bringing the total number of quality indicators to 65. CONCLUSION: This study establishes consensus-derived multidisciplinary quality indicators for LSG operative reports. Application of these findings aims to advance the quality and completeness of operative reporting in LSG in order to improve communication of important surgical details and quality measures to the multidisciplinary team involved in bariatric surgery care.

Impact of acute care surgery on timeliness of care and patient outcomes: a systematic review of the literature

Background: Dedicated emergency general surgery (EGS) service models were developed to improve efficiency of care and patient outcomes. The degree to which the EGS model delivers these benefits is debated. We performed a systematic review of the literature to identify whether the EGS service model is associated with greater efficiency and improved outcomes compared to the traditional model. Methods: We searched MEDLINE, Embase, Scopus and Web of Science (Core Collection) databases from their earliest date of coverage through March 2017. Primary outcomes for efficiency of care were surgical response time, time to operation and total length of stay in hospital. The primary outcome for evaluating patient outcomes was total complication rate. Results: The EGS service model generally improved efficiency of care and patient outcomes, but the outcome variables reported in the literature varied. Conclusion: Development of standardized metrics and comprehensive EGS databases would support quality control and performance improvement in EGS systems.

Contexte: Des modèles dédiés de services de chirurgie générale d'urgence (CGU) ont été développés pour améliorer l'efficience des soins et les résultats chez les patients. On ne s'entend toutefois pas sur l'ampleur des bénéfices conférés par le modèle CGU. Nous avons procédé à une revue systématique de la littérature afin de vérifier si le modèle CGU est associé à une plus grande efficience et à de meilleurs résultats comparativement au modèle classique. Méthodes: Nous avons interrogé les bases de données MEDLINE, Embase, Scopus et Web of Science (collection centrale) depuis la plus ancienne couverture du sujet et jusqu'à mars 2017. Les paramètres principaux pour l'efficience des soins étaient le temps de réponse, le délai avant l'intervention et la durée totale du séjour hospitalier. Le paramètre principal pour l'évaluation des résultats chez les patients était le taux de complications total. Résultats: Le modèle de service CGU améliore généralement l'efficience des soins et les résultats chez les patients, mais dans la littérature, les paramètres mesurés varient. Conclusion: Le développement de paramètres standardisés et de bases de données globales sur la CGU appuierait le contrôle de la qualité et l'amélioration du rendement des systèmes CGU.

Impact of a Preoperative Exercise Program on General Fitness in Patients Awaiting Bariatric Surgery: A Pilot Randomized Trial.

Background Evidence supports the association between exercise and outcomes following bariatric surgery. However, there is a lack of knowledge regarding the short-term benefits of preoperative exercise. Objectives The objective of this pilot study was to evaluate the feasibility and functional benefits of a 12-week preoperative exercise program in patients awaiting bariatric surgery. The primary aim was the six-minute walk test (6MWT). The secondary aim of this study included anthropometric measures, strength, and quality of life. Methods A total of 54 patients were enrolled in this pilot randomized controlled study. Of them, 29 patients received standard multidisciplinary preoperative care, while 25 patients participated in a 12-week supervised exercise program in addition to standard preoperative care consisting of strength and aerobic exercises three times per week in a fitness facility. The primary outcome was improvement in 6MWT. Secondary outcomes included other functional outcomes, quality of life, and anthropometric measures. Results Average attendance for the intervention group was 27.2 (75.6%) of 36 sessions. There was a mean improvement of 27 ± 10 meters in the intervention group compared with a reduction of 5 ± 10 meters in the control group (p = 0.003). Patients in the intervention group had significant improvement in all self-reported quality-of-life domains, particularly in the variables related to symptoms, hygiene, and emotions. Conclusions A 12-week preoperative exercise intervention was feasible and showed association with a statistically significant improvement in 6MWT and quality-of-life measures in patients awaiting bariatric surgery. The results of this study will inform sample size calculations and recruitment planning for a future study that will assess the longer-term benefits of a pre-surgical fitness intervention.

A survey of primary care physician referral to bariatric surgery in Manitoba: access, perceptions and barriers.

BACKGROUND: There is an important disconnect between surgical programs and primary care physicians (PCP) in the delivery of bariatric care. The objective of this study is to assess PCP knowledge and perception of a provincial bariatric surgery program. METHODS: A 32-question, IRB approved, survey was developed by bariatric surgery experts and vetted by local PCPs. A single round of paper surveys was administered to 1,000 PCPs between July and September 2015. Continuous variables were assessed by t-test and categorical variables by Chi-square test. RESULTS: There were 131 survey responses (13.1%). Half (54.2%) of respondents did not feel equipped to counsel their patients on operative management strategies. PCPs counselled on average 11.6%±17.0% of their obese patients on bariatric surgery. Many respondents (58.3%) thought excess weight loss from gastric bypass was less than 40% and most believed there was less than 50% resolution of diabetes (62.4%), hypertension (72.3%), dyslipidemia (77.8%) and obstructive sleep apnea (60.6%). PCPs who referred patients to the bariatric program (71.8%) were more comfortable counselling their patients on bariatric surgery options (56.8% vs. 17.1%, P<0.001) and were more comfortable with post-operative care (67.4% vs. 38.2%, P=0.004). Additionally, these PCPs estimated higher rates of diabetes and hypertension resolution post-bariatric surgery. The predominant perceived barrier to accessing bariatric surgery was wait times (33.3%). CONCLUSIONS: PCPs appear to underestimate the efficacy of bariatric surgery in the treatment of obesity and feel ill-equipped to counsel patients. Further education related to bariatric surgery may improve PCP comfort in counselling and long-term follow-up.