Morbid Obesity Requiring Bariatric Surgery, Severe Obesity
Conditions
Keywords
bariatric surgery, early discharge, hospiral-at-home, enhanced recovery after surgery, ERAS, healthcare costs, health resource utilization, economic evaluation, postoperative care, severe obesity
Brief summary
Bariatric surgery is the most effective treatment for severe obesity and its associated diseases. Advances in surgical techniques, enhanced recovery protocols, and multimodal perioperative care have made earlier hospital discharge possible while maintaining patient safety. This observational cohort study aims to evaluate the economic impact of an early discharge pathway consisting of 24 hours of hospital stay followed by Hospital-at-Home care, compared with the conventional 48-hour hospital stay after bariatric surgery. The study will compare healthcare costs, resource utilization, clinical safety, organizational efficiency, applicability of the early discharge pathway, and patient satisfaction between both postoperative care models under routine clinical practice.
Detailed description
The implementation of Enhanced Recovery After Surgery (ERAS) protocols, minimally invasive surgical techniques, and optimized multimodal perioperative management has significantly improved postoperative recovery after bariatric surgery, allowing earlier hospital discharge without compromising patient safety. At Hospital Universitari Parc Taulí, an early discharge pathway combining 24 hours of postoperative hospital stay with structured Hospital-at-Home (HaH) care during the second postoperative day was implemented as part of routine clinical practice in February 2025. This model was developed to optimize healthcare resource utilization while maintaining the same overall duration of postoperative medical supervision as the conventional pathway. This study is an ambispective comparative observational cohort study designed to evaluate the economic impact of this postoperative care pathway under real-world clinical conditions. Patients managed with the conventional 48-hour hospital stay before implementation of the protocol will be compared with patients managed using the early discharge plus Hospital-at-Home pathway after implementation. The study will evaluate direct healthcare costs, healthcare resource utilization, clinical safety, organizational efficiency, applicability of the early discharge pathway, and patient satisfaction. The results are expected to provide evidence regarding the economic and organizational impact of Hospital-at-Home as an alternative postoperative care model following bariatric surgery within a public healthcare system.
Interventions
None listed
Sponsors
Corporacion Parc Tauli
Study design
Observational model
COHORT
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older. * Patients undergoing elective bariatric surgery. * Bariatric surgery performed during the predefined study periods for either cohort. * Availability of sufficient clinical and economic data for study analysis.
Exclusion criteria
* Emergency surgery. * Intraoperative complications requiring postoperative management outside the standard care pathway. * Unplanned admission to an intensive care unit. * Incomplete clinical or economic data preventing study analysis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Direct Healthcare Cost per Patient | Within 90 days after bariatric surgery | Mean direct healthcare cost per patient, including hospital stay, Hospital-at-Home care, emergency department visits, hospital readmissions, and additional healthcare resources used during the postoperative follow-up period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of Hospital Stay | From surgery until hospital discharge (approximately 24-48 hours). | Length of conventional inpatient hospital stay following bariatric surgery, measured in days. |
| Hospital-at-Home Utilization | During the Hospital-at-Home follow-up period (postoperative day 2). | Utilization of the Hospital-at-Home program, assessed by the number of home care days and home visits provided after hospital discharge. |
| Emergency Department Visits | Within 90 days after bariatric surgery. | Number of postoperative emergency department visits occurring during the follow-up period, regardless of the reason for consultation. |
| Hospital Readmissions | Within 90 days after bariatric surgery. | Number of hospital readmissions occurring during the postoperative follow-up period. |
| Postoperative Complications | Within 90 days after bariatric surgery. | Incidence and severity of postoperative complications, including complications classified according to the Clavien-Dindo classification, reinterventions, and postoperative mortality. |
| Hospital Bed-Days Saved | Perioperative (from surgery until hospital discharge, up to 48 hours) | Number of conventional hospital bed-days saved by implementing the early discharge pathway with Hospital-at-Home compared with the conventional postoperative care pathway. |
| Applicability of the Early Discharge Pathway | Perioperative (from surgery until discharge allocation, up to 48 hours) | Proportion of patients eligible for and successfully managed with the early discharge pathway including Hospital-at-Home care, as well as the reasons for non-inclusion when applicable. |
| Patient Satisfaction | At completion of postoperative follow-up (within 90 days after bariatric surgery). | Patient satisfaction assessed using a structured questionnaire evaluating the information received, hospital stay, Hospital-at-Home care, anxiety related to home recovery, overall satisfaction, willingness to repeat the care pathway, and willingness to recommend it to other patients. |
Countries
Spain
Contacts
CONTACTNoelia Pérez Romero, MD, PhD
Outcome results
None listed