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Journal of Anesthesia

, Volume 32, Issue 2, pp 227–235 | Cite as

Satisfaction rate of patients undergoing sleeve gastrectomy as day-case surgery compared to conventional hospitalization: a prospective non-randomized study

  • Rachid Badaoui
  • Lionel Rebibo
  • Kahina Kirat
  • Youssef Alami
  • Abdelhakim Hchikat
  • Cyril Cosse
  • Jean-Marc Regimbeau
  • Emmanuel Lorne
Original Article

Abstract

Purpose

Day-case surgery (DCS) has boomed over recent years. However, day-case bariatric surgery remains controversial due to a lack of evaluation. The objective of this study was to compare the experiences and satisfaction with general anesthesia of patients undergoing sleeve gastrectomy (SG) as DCS compared to conventional hospitalization.

Methods

Between January 2015 and June 2016, all patients undergoing primary SG as day-case surgery or with conventional hospitalization were prospectively included in this non-randomized, non-inferiority study comparing the level of satisfaction of patients undergoing SG with conventional hospitalization (CH group, gold standard) versus SG as DCS (DCS group). The primary efficacy endpoint was comparison of the overall satisfaction rate using the EVAN-G questionnaire. The secondary endpoints were evaluation of the 6 dimensions of the EVAN-G questionnaire, discharge from hospital, adhesion with SG management and overall satisfaction with SG.

Results

One-hundred and twenty-four patients met the inclusion criteria (62 in both groups). The DCS group was younger with fewer comorbidities (p ≤ 0.01) and had a lower BMI (p ≤ 0.01). Overall, the mean EVAN-G questionnaire score was 66.4 (63.9–68.9) for the DCS group and 68.9 (65.9–71.8) for the CH group (non-inferiority of DCS group). In the DCS group, 19% of patients would have preferred to spend the night in hospital, while 82% of patients in the CH group would have preferred DCS and a total of 75% of patients reported a high level of satisfaction.

Conclusion

Overall satisfaction of patients undergoing SG as day-case surgery was not inferior to that of patients managed by conventional hospitalization.

Keywords

Bariatric surgery Day-case surgery Satisfaction rate Sleeve gastrectomy 

Abbreviations

SG

Sleeve gastrectomy

LOS

Length of hospital stay

OSA

Obstructive sleep apnea syndrome

DCS

Day-case surgery

CH

Conventional hospitalization

POD

Postoperative day

BMI

Body Mass Index

Introduction

Several studies have reported an increasing incidence of obesity, which now constitutes a global public health problem that affects all ages, all socioeconomic classes and all parts of the world [1, 2, 3]. Bariatric surgery has yielded good results in terms of weight loss, correction of cardiovascular risk factors and change in lifestyle [4]. Laparoscopic sleeve gastrectomy (SG) has become increasingly popular because of the apparent ease of this technique and its good results (in terms of weight loss and improvement of comorbidities) [5]. Low postoperative complication rates have been reported compared to duodenal switch [6] or Roux-en-Y gastric bypass [7] due to the absence of anastomosis.

Day-case surgery is becoming increasingly popular for three main reasons. Firstly, avoidance of overnight hospitalization reduces the risk of hospital-acquired infections. Secondly, day-case management can improve the quality of care and raise the levels of patient satisfaction without adding any additional risk. Lastly, the cost of admission to a DCS unit is undoubtedly lower than that of conventional hospitalization.

Day-case surgery remains the subject of a number of criticisms and few studies have compared the satisfaction rate of patients undergoing day-case surgery (DCS) versus conventional hospitalization (CH). Patient satisfaction is a key indicator of quality to be considered when evaluating clinical practices [8, 9], which must be compatible with the patient’s expectations. Only limited data have been published in the literature on patients undergoing day-case bariatric surgery, and the satisfaction of patients undergoing day-case bariatric surgery has never been studied.

The objective of this study was to compare the experiences and satisfaction with general anesthesia of patients undergoing SG as day-case surgery compared to patients undergoing SG with conventional hospitalization.

Materials and methods

This was a prospective, observational, non-randomized study of a group of patients undergoing day-case or conventional SG between January 2015 and June 2016. This non-inferiority study compared the level of satisfaction of patients undergoing SG with conventional hospitalization (forming the CH group, considered to be the gold standard) to that of patients undergoing DCS SG (forming the DCS group).

This study was approved by the Amiens University Hospital non-interventional research ethics committee (CEERNI). All patients were provided with a patient information sheet during a preoperative consultation and all patients provided their written informed consent to participate. Day-case SG was previously validated in our institution based on a local research protocol entitled “Feasibility of Laparoscopic Sleeve Gastrectomy in Day-Case Surgery (GASTRAMBU)” (ClinicalTrials.gov Identifier NCT01513005).

In our institution, it is usual to allocate all patients who are planned for SG into the CH or DCS according to the criteria descripted in ‘Specific indication for SG as day-case surgery’ section. It is usual to perform EVAN-G questionnaire for all postoperative patients who undergo SG in our institution. Our institutional review board concluded that the registration was not required for this study (including performing additional questionnaire).

Indication for bariatric surgery

The indication for bariatric surgery was validated in accordance with French national guidelines and a multidisciplinary obesity staff meeting [10].

Specific indication for SG as day-case surgery

The inclusion criteria for SG as day-case surgery have been previously described [11]. Briefly, inclusion criteria were Body Mass Index (BMI) between 35 and 60 kg/m2, absence of significant medical history (cardiovascular and/or pulmonary diseases, no history of major abdominal surgery), treatment-compliant patients aged between 18 and 60 years, living within an hour’s drive of a hospital and with an on-site support person available for the night after surgery, access to a telephone and an American Society of Anesthesiologists score of I, II or controlled III [12]. Patients were excluded from day-case surgery in the presence of heart disease (history of myocardial infarction, cardiac arrhythmia, anticoagulation or antiplatelet therapy) or OSA, poorly controlled diabetes, or when they were a prisoner or were thought to be poorly compliant.

Description of the various care pathways

Conventional hospitalization

A preoperative anesthetic consultation was performed at least 2 weeks before SG by an anesthetist with an extensive experience of anesthesia of obese patients undergoing bariatric surgery. Patients were admitted the day before surgery (Fig. 1).
Fig. 1

Organizational design of day-case surgery and conventional hospitalization. SG sleeve gastrectomy

Day-case management

A preoperative anesthetic consultation was performed at least 2 weeks before day-case SG by an anesthetist with an extensive experience of day-case surgery, but without an extensive experience of anesthesia and postoperative management of obese patients undergoing bariatric surgery. Patients were admitted on the day of surgery (Fig. 1).

Anesthetic procedure

The anesthetic protocol was specifically developed for day-case SG [13] and was then extended to SG performed with conventional hospitalization during the study period. All patients received treatment with cimetidine (400 mg) and premedication with hydroxyzine (1.5 mg/kg) was administered 30 min before anesthesia for anxious patients. Patients wore compression stockings since the night before surgery. In the operating room, pressure points were checked and secured during patient positioning, and antibiotic prophylaxis with cefazolin (4 g) was administered, followed by 5 min of preoxygenation with 100% oxygen in a beach chair position. General anesthesia was induced with propofol (2.5 mg/kg), sufentanil (0.5 µg/kg), and rocuronium (1 mg/kg of real body weight) to facilitate tracheal intubation. Anesthesia was maintained with 4–6% desflurane and 0.1–0.25 µg/kg/min remifentanil. The objective of mechanical ventilation was to maintain arterial oxygen saturation above 95% and CO2 between 30 and 35 mmHg with a 50% inhaled oxygen concentration. Standard monitoring included the use of a cardiac monitor and pulse oximeter (SpO2) and measurements of heart rate (HR), end-tidal CO2 (EtCO2), and noninvasive blood pressure monitoring. Muscle relaxation was monitored with a TOF Watch (TOF Watch®, Alsevia Pharma, 75016 Paris, FRANCE). The depth of anesthesia was monitored by bispectral index (BIS) (BIS™ Quatro (4 Electrode) Sensor & BIS™ Complete 2-Channel Monitor, Medtronic, 92100 Boulogne Billancourt, FRANCE) and was maintained at BIS values between 40 and 60. Intraoperative hypothermia was prevented by a warming system (3M™ Bair Hugger™, 3M, 95006 Cergy-Pontoise Cedex, France). Neuromuscular blockade was systematically reversed using sugammadex (4 mg/kg) when TOF was equal to or greater than 2 and the patient was extubated in the operating room. Multimodal postoperative analgesia included nefopam (20 mg), tramadol (100 mg), and paracetamol (1 g), started 30 min before the end of surgery, and completed by intravenous morphine titration in the recovery room when the visual analog scale was greater than 30 mm. To prevent postoperative nausea and vomiting (PONV), patients routinely received dexamethasone (8 mg) and droperidol (1.25 mg) at the time of induction of anesthesia, and ondansetron (4 mg) during the postoperative period. All drug doses were calculated based on ideal body weight.

Postoperative management

Conventional hospitalization

After SG, patients were admitted to the conventional recovery room and were then transferred to the digestive surgery ward. Oral refeeding was authorized in the evening after SG. The patient was deemed suitable for discharge on the day following SG in the absence of any particular symptoms after food intake. A surgical follow-up visit was planned on POD 30 (Fig. 1).

Day-case surgery

Day-case management has been described previously [1114]. Briefly, after surgery, patients were first admitted to the day-case surgery recovery room and were then transferred to the day-case surgery unit for assessment of vital signs (temperature, heart rate, blood pressure and oxygen saturation), any postoperative nausea and pain and collection of a blood sample for determination of the hemoglobin level. The patient was deemed suitable for discharge on the same day in the absence of any particular symptoms after food intake during recovery and after examination by both the surgeon and the anesthetist. When these conditions were not met, the patient was hospitalized overnight. Patients were always contacted by the day-case surgery unit nurse on postoperative day (POD) one and were always reviewed in the clinic on POD4 (specific scheduled consultation for day-case SG) including complete physical examination and blood biochemistry. Patients were then reviewed on POD 30 (Fig. 1).

Evaluation of patient satisfaction

EVAN-G questionnaire

Satisfaction with day-case surgery and conventional hospitalization management was evaluated using the EVAN-G questionnaire. The EVAN-G questionnaire is a questionnaire evaluating the experiences of general anesthesia and is validated for both day-case surgery and conventional hospitalization [15].

The EVAN-G questionnaire comprises 6 dimensions assessing satisfaction in relation to 26 items: attention, information, privacy, management of pain, discomfort and waiting times (Supplementary Figure). Each dimension was evaluated using a five-point verbal scale. The EVAN-G score is expressed as a global score out of 100, and the score of each of the 6 dimensions expressed as a percentage.

Other questionnaires

Other questionnaires were specifically designed for this study:
  • Evaluation of discharge from hospital, including preparation for discharge from hospital and experience at home, expressed as a score out of 100, as for the EVAN-G questionnaire:
    • Preparation for discharge (four items): information on monitoring, warning signs, resumption of activity and the feeling of being discharged too quickly.

    • Experience at home (three items): pain, discomfort, and functional discomfort at home.

  • Adhesion to the procedure was evaluated by additional binary questions concerning adhesion to the procedure and overall satisfaction with the type of management. The patient was asked whether they:
    • Would have preferred to spend the night in hospital (in the case of day-case SG), or be discharged home on the day of surgery (in the case of conventional hospitalization),

    • Would make the same choice if they had to undergo the procedure again,

    • Would recommend this type of management to a loved one.

  • Overall satisfaction with SG using a 5-point verbal scale. The level of satisfaction was considered to be high when the answer was “very satisfied” or “completely satisfied”.

Methodology of evaluation of patient satisfaction

Patients included in this study were informed about participation in this study and its modalities during the preoperative anesthetic consultation. Each patient was contacted by telephone on postoperative day (POD) by an independent anesthetist who did not participate in their management, to fill in the questionnaire.

Study endpoints

The primary endpoint was comparison of the satisfaction rate of patients undergoing SG as day-case surgery and with conventional hospitalization according to the score of the EVAN-G questionnaire [15]. The secondary endpoints were evaluation of the 6 dimensions of the EVAN-G questionnaire, evaluation of discharge from hospital, evaluation of adhesion and satisfaction with SG management and overall satisfaction with the SG procedure.

Inclusion and exclusion criteria

Inclusion criteria were patients undergoing SG as day-case surgery or with conventional hospitalization on the same day and scheduled at the beginning of the operating list (about 9:00 a.m.). To avoid bias when evaluating satisfaction rates, patients undergoing SG with conventional hospitalization at the beginning of the operating list were included, as SG as day-case surgery was always performed at the beginning of the day-case surgery operating list. Exclusion criteria were patients refusing to participate in the study or failing to answer the postoperative phone call, unscheduled overnight admission after day-case SG and postoperative complications following SG.

Sample size calculation and statistical analysis

It was assumed that day-case surgery management would not be inferior to conventional hospitalization in terms of the satisfaction rate after SG. The sample size was calculated on the basis of published data reported by Auquier et al. [15] and an expected mean and standard deviation of 75 ± 14. With a non-inferiority margin of 7% of the mean and a two-sided α risk of 5% and a β risk of 20%, a sample size of 62 patients per group was required. Non-inferiority would be established if the upper limit of the two-sided 95% confidence interval of the difference of satisfaction rates between the 2 groups was lower than the non-inferiority margin.

Patients in the two groups were divided into pairs (based on date and position on the operating list). When a patient in one group had to be excluded from the study, the paired patient in the other group was also excluded. Patients undergoing SG on the same day were included in order to reduce the risk of bias related to external events and all SG procedures were performed at the beginning of the operating list to avoid any bias related to the time to oral feeding after SG.

Quantitative variables with a non-normal distribution were expressed as median (IQR) for the variables and variables with a normal distribution were expressed as mean (95% confidence interval). Normal distribution was assessed by the d’Agostino-Pearson test. Qualitative variables were expressed as a percentage with 95% confidence interval and were compared by a Chi square test. A non-inferiority test (Welch’s t test) was performed for the global score (primary endpoint) and the scores for each dimension. The limit for statistical significance was p ≤ 0.05. All statistical analyses were performed with SAS software (version 9.2, SAS Institute, Cary, NC, USA). The study was conducted according to STROBE guidelines.

Results

Study population

Of the 140 patients initially selected, 124 patients met the inclusion criteria (62 in the SG day-case surgery group and 62 in the conventional hospitalization group) (Fig. 2). Reasons for exclusion were: no response in two patients, unplanned overnight admission in three patients, major postoperative complications in three patients (one gastric leak in the SG day-case surgery group, one hematoma and one case of postoperative bleeding in the conventional hospitalization group).
Fig. 2

Study flow chart. SG sleeve gastrectomy. Asterisk: patients with unplanned overnight admission. Double asterisks: patients with major postoperative complications

Patient characteristics are summarized in Table 1. Globally, the day-case SG group was younger with fewer comorbidities and a lower BMI. The majority of patients undergoing SG as day-case surgery were females (92%) (Table 1).
Table 1

Preoperative data of patients undergoing SG as day-case surgery or with conventional hospitalization

 

DCS group (n = 62)

CH group (n = 62)

p

Age in years (range)

34 ± 9 (19–52)

42 ± 11 (21–62)

≤ 0.0001

Male gender (%)

5 (8)

16 (26)

≤ 0.01

BMI (kg/m2)

41.8 ± 3.5 (35–51)

44.2 ± 6.1 (35–60)

≤ 0.01

Hypertension (%)

9 (15)

21 (34)

0.01

Type 2 diabetes (%)

2 (3)

15 (24)

≤ 0.001

OSA (%)

0 (0)

20 (32)

≤ 0.0001

Dyslipidaemia (%)

6 (10)

13 (21)

≤ 0.001

GERD (%)

7 (11)

7 (11)

1

Asthma (%)

1 (2)

7 (11)

0.07

Depression (%)

1 (1.6)

3 (5)

0.61

BMI Body Mass Index, OSA obstructive sleep apnoea, GERD gastro-oesophageal reflux disease, DCS day-case surgery, CH conventional hospitalisation

Surgical procedure and postoperative data

All procedures were performed laparoscopically. The mean operating time (± SD (range) was 57 ± 11 min (35–65) for day-case SG and 66 ± 14 min (35–85) for SG with conventional hospitalization. Abdominal drainage was not required in either of the two groups.

By comparing pain scores at admission and discharge from the post-anesthesia care unit (PACU) (Table 2), when leaving the operating room, 83.8% of patients in the DCS group and 80.6% of patients in the CH group experienced no pain or only mild pain (p = 0.43). When leaving the PACU, 93.5 and 92% of patients experienced no pain or only mild pain, respectively (p = 0.62). Data on PACU are summarized in Table 2.
Table 2

PACU data on SG performed as day-case surgery or as conventional hospitalization

 

DCS group (n = 62)

CH group (n = 62)

p

Absent or mild pain at PACU admission (%)

52 (83.8)

50 (80.6)

0.43

Absent or mild pain at PACU discharge (%)

58 (93.5)

57 (92)

0.62

Use of morphine medication (%)

7 (11.3)

7 (11.3)

0.65

Use of ondansetron (%)

4 (6.4)

6 (9.6)

0.21

No PONV at PACU discharge (%)

52 (83.8)

49 (79)

0.38

Mean stay at PACU in minutes (range)

80 (35–140)

100 (45–155)

≤ 0.05

DCS day-case surgery, CH conventional hospitalisation, PACU postoperative care unit, PONV postoperative nausea and vomiting

Three patients undergoing day-case SG required overnight admission and were all discharged at POD 1. The mean LOS for conventional SG was 1.9 days (1–3).

EVAN-G questionnaire

The mean global score for the EVAN-G questionnaire was 66.4 ± 9.9 (63.9–68.9) and 68.9 ± 11.8 (65.9–71.8) for SG as day-case surgery and SG with conventional hospitalization, respectively. The non-inferiority of day-case surgery vs conventional hospitalization was demonstrated, as the difference was less than 5 points (p ≤ 0.001—non-inferiority test).

Globally, no significant difference was observed between the DCS and CH groups except for “waiting times” (Table 3).
Table 3

Results of EVAN-G items according to the type of management

 

DCS group (n = 62)

CH group (n = 62)

p

Global index (95% CI)

66.4 ± 9.9 (63.9–68.9)

68.9 ± 11.8 (65.9–71.8)

≤ 0.001

Attention (95% CI)

53.1 ± 14.7 (51.4–58.8)

56.5 ± 18.2 (51.4–58.8)

0.06

Information (95% CI)

58.7 ± 18.8 (53.9–63.5)

67.8 ± 22.9 (62.1–73.4)

0.76

Privacy (95% CI)

55.5 ± 9.9 (52.9–57.9)

59.2 ± 15.4 (55.4–63.1)

0.11

Pain (95% CI)

67.2 ± 22.7 (59.5–70.9)

61.2 ± 23.9 (55.2–67.1)

0.09

Discomfort (95% CI)

78.8 ± 18.2 (74.1–83.4)

83.2 ± 16.8 (79.1–87.4)

0.09

Waiting (95% CI)

85.3 ± 20.8 (79.9–90.6)

85.6 ± 22.5 (80.0–91.1)

0.04

DCS day-case surgery, CH conventional hospitalisation

Other questionnaires

The scores on the discharge questionnaire were similar between SG as day-case surgery and SG with conventional hospitalization (71 (65.8–77.2) vs 71 (65.9–75.7), respectively; p = 0.7). Similar scores were also reported for the experience at home: 85 (73–94) for SG as day-case surgery vs 83 (72–93) for SG with conventional hospitalization (p = 0.56).

On the additional binary questionnaire, 19% of patients in the DCS group would have preferred to spend the night in hospital, while 82% of patients in the CH group would have preferred to have been discharged on the same day as surgery. Surprisingly, 98% of patients in the DCS group would recommend this type of management. The results for the binary questionnaire are summarized in Table 4 and showed statistically significant differences for all variables. Seventy-five per cent of patients reported a high level of satisfaction with the global management of SG. No significant differences were observed between DCS and CH group (Table 5).
Table 4

Results of additional binary questionnaire

 

Yes

No

No response

p value

Would you have preferred to spend the night in hospital (for DCS group) (%)

12 (19)

48 (78)

2 (3)

< 0.001

Would you have preferred to have been discharge the same day as SG (for CH group) (%)

51 (82)

11 (18)

0 (0)

< 0.001

Would you choose the same option if you had to do it again (%)

 DCS group

60 (97)

2 (3)

0 (0)

< 0.001

 CH group

59 (95)

3 (5)

0 (0)

< 0.001

Would you recommend this type of management to a friend (%)

 DCS group

61 (98)

1 (2)

0 (0)

< 0.001

 CH group

56 (90)

6 (10)

0 (0)

< 0.001

SG: sleeve gastrectomy, DCS: day-case surgery, CH: conventional hospitalisation

Table 5

Overall evaluation of satisfaction to perform SG depending type of management

 

Not at all satisfied

Poorly satisfied

Satisfied

Very satisfied

Completely satisfied

p value

DCS group (%)

2 (3)

6 (9.5)

6 (9.5)

18 (29)

30 (49)

0.77

CH group (%)

1 (1.5)

8 (13)

8 (13)

20 (32)

25 (40.5)

Total (%)

3 (2.4)

14 (11.3)

14 (11.3)

38 (30.6)

55 (44.4)

SG sleeve gastrectomy, DCS day-case surgery, CH conventional hospitalisation

Discussion

In the series by Auquier et al. [15], the mean score of the cohort allowing validation of the EVAN-G score was 75 ± 14. The series by Franck et al. [16], which validated evaluation of satisfaction with emergency day-case surgery, reported a high satisfaction rate of 82 (79–84). The lower satisfaction rates observed in this study compared to the literature may be due to the lower mean age and BMI of the study population. Auquier et al. [15] reported that higher scores were observed in older patients, while the population in the present study was younger than in the majority of studies using EVAN-G score and this younger sample was, therefore, probably more demanding. Several previous studies have described the negative impact of obesity on the doctor–patient relationship [17, 18]. Wee et al. showed that the level of satisfaction was inversely proportional to BMI [19]. The patient’s weight is also related to care-related patient satisfaction and obese patients reported lower levels of satisfaction for most aspects of care compared to normal-weight patients [19]. The difference between our results and those of other series can, therefore, be explained by the fact that the EVAN-G questionnaire has been validated for general surgery populations, while the present study was conducted in a specific population and the EVAN-G questionnaire may not be sensitive to the quality of care related to the patient’s weight. This point constitutes one of the limitations of this study, as patients were not explicitly asked whether they thought that their weight affected the way in which they were treated by caregivers, or whether patients thought that the teams had negative opinions concerning them because of their weight, resulting in poorer quality of care.

The lowest scores of the EVAN-G questionnaire were observed for the information dimension in all studies using this questionnaire [15, 16]. Comparison of the two types of management showed even poorer results for this dimension in the DCS group (58.7 for day-case SG vs. 67.8 for SG with conventional hospitalization) (Table 3). These results are fairly surprising, but can be explained by the fact that the preoperative anesthetic consultation prior to day-case SG was conducted by anesthetist with extensive experience in day-case surgery, but no experience in bariatric surgery and who therefore probably provided poorer quality information about the specific aspects of bariatric surgery during the preoperative consultation.

The day-case SG group reported better pain control, which corroborates the fact that day-case SG can be performed as a primary procedure, as it is painless and the ambulatory setting places the patient at the center of his/her management, making the patient less dependent on the nursing team. In day-case surgery, analgesics are only administered in the presence of symptoms and not systematically. In conventional hospitalization, patients do not always receive all prescribed does of analgesics, and analgesic administration may sometimes be delayed. It has been estimated that only 50% of patients experiencing pain actually receive analgesics [20].

Eighty per cent of patients undergoing SG with conventional hospitalization indicated that they would accept day-case surgery if it were proposed (Table 4). One explanation for these results could be the short length of hospital stay, similar to that of day-case surgery. In contrast, 19% of patients in the day-case SG group would have preferred to spend the night in hospital, as they would have felt reassured by spending the first night in hospital. Many patients in the DCS group reported anxiety during the first night at home and said that they would have been psychologically reassured by spending the first night in hospital, without affecting their overall satisfaction with day-case surgery. A non-medicalized structure close to the hospital could possibly constitute a good alternative in these patients [21].

The scores for the “preparation for discharge from hospital” and “experience at home” dimensions of the additional questionnaire were higher than the EVAN-G score, although they assessed the same items (Table 4). This difference between the two questionnaires highlights the problems of understanding of some of the items of the EVAN-G questionnaire. A similar discrepancy was also observed when analyzing the responses to the additional binary questionnaire, as the majority of patients were satisfied with the proposed procedure and would recommend it. A higher level of satisfaction (with 75% of very and completely satisfied patients) was also observed on the additional questionnaire compared to the EVAN-G questionnaire, raising the question of the validity of the EVAN-G score in obese patients, who constitute a specific population. Specific questionnaires evaluating quality of life after bariatric surgery have been proposed, but appear to be over-simplified [22].

The major limitation of this study was that it was not a randomized study and comprised two fairly different populations with a higher BMI, a higher proportion of males and more comorbidities in the CH group, which could induce a bias in this study. A randomized design could have increased the impact of this study, but only three series on day-case SG have been published to date [11, 23, 24] and data on the feasibility and safety of day-case SG are currently lacking. A randomized study in our center would have required the inclusion of only those patients presenting the criteria for day-case surgery and would, therefore, have decreased the day-case SG rate.

Conclusion

Overall satisfaction of patients undergoing SG as day-case surgery was not inferior to patients managed with conventional hospitalization. A specialist anesthetist consultation should be preferred prior to day-case bariatric surgery, due to the specific characteristics of patients undergoing bariatric surgery. The satisfaction scores observed in this study were lower than those reported in the literature. Moreover, discrepancies were observed between the results of the EVAN-G questionnaire and the additional questionnaires, probably mainly related to the characteristics of our bariatric surgery population.

Notes

Funding

Support was provided solely from institutional source.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest to declare.

Supplementary material

540_2018_2469_MOESM1_ESM.tif (626 kb)
List of the 26 EVAN-G items according to [15] (TIFF 626 kb)

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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  • Rachid Badaoui
    • 1
  • Lionel Rebibo
    • 2
  • Kahina Kirat
    • 1
  • Youssef Alami
    • 1
  • Abdelhakim Hchikat
    • 1
  • Cyril Cosse
    • 2
  • Jean-Marc Regimbeau
    • 2
    • 3
    • 4
    • 6
  • Emmanuel Lorne
    • 1
    • 5
  1. 1.Department of AnesthesiologyAmiens University HospitalAmiens Cedex 01France
  2. 2.Department of Digestive SurgeryAmiens University HospitalAmiens Cedex 01France
  3. 3.EA4294Jules Verne University of PicardieAmiens Cedex 01France
  4. 4.Clinical Research CenterAmiens University HospitalAmiens Cedex 01France
  5. 5.INSERM U1088Jules Verne University of PicardyAvenue René LaennecFrance
  6. 6.Service de chirurgie digestive, Hôpital SudCHU d’AmiensAmiens Cedex 01France

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