A Hub and Spoke Learning Program in Bariatric Surgery in a Small Region of Italy

Frontiers in Surgery

article

Antonio Buondonno¹  Pasquale Avella²  Micaela Cappuccio²  Andrea Scacchi²  Roberto Vaschetti²  Giancarlo Di Marzo¹  Pietro Maida³  Claudio Luciani¹  Bruno Amato⁴  Maria Chiara Brunese²  Daniela Esposito⁵  Lucio Selvaggi⁶  Germano Guerra²  Aldo Rocca¹ 

[1] General Surgery Unit, A. Cardarelli Hospital;Department of Medicine and Health Science, University of Molise;General Surgery Unit, Ospedale del Mare;Department of Clinical Medicine and Surgery, University of Naples Federico II;Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital;Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”

关键词: bariatric surgery;    Hub and Spoke;    sleeve gastrectomy;    BioEnterics Intragastric Balloon;    metabolic surgery;    obesity;   

DOI  :  10.3389/fsurg.2022.855527

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Metabolic and bariatric surgery (BS) are considered life-changing and life-saving treatments for obese patients. The Italian Society of Obesity Surgery (SICOB) requires at least 25 operations per year to achieve the standard of care in the field. Despite the increasing need to treat obese patients, some small southern regions of Italy, such as Molise, do not have enough experience in bariatric procedures to be allowed to perform them. Therefore, our aim was to run a Hub and Spoke Program with a referral center in BS to treat obese patients and provide a proper learning curve in BS in Molise. Methods In 2020, the “A. Cardarelli Hospital” in Campobasso, Molise, started a formal “Learning Model of Hub and Spoke Collaboration” with the Hub center “Ospedale Del Mare”, Naples. A multidisciplinary approach was achieved. Patients were supervised and operated under the supervision and tutoring of the referral center. We retrospectively reviewed our prospectively collected database from February 2020 to August 2021 in order to analyze the safety and effectiveness of our learning program. Results In total, 13 (3 men and 10 women) patients underwent BS with the mean age of 47.08 years and a presurgery BMI of 41.79. Seven (53.84%) patients were the American Society of Anesthesiologist (ASA) II, and 6 (46.16%) patients were ASA III. Twelve (92.31%) procedures were laparoscopic sleeve gastrectomies, 1 (7.69%) patient underwent endoscopic BioEnterics Intragastric Balloon (BIB) placement. One (8.33%) sleeve gastrectomy was associated to gastric band removal. Mean surgical time was 110.14 ± 23.54 min. The mean length of stay was 4.07 ± 2.40 days. No Clavien-Dindo ≥ III and mortality were reported. The follow-up program showed a mean decrease of 11.82 in terms of body mass index (BMI) value. The last 5 procedures were performed by the whole equips from “A. Cardarelli” under external tutoring without any impact on complication rate. Conclusion The setup of a proper Hub and Spoke Program may allow to perform BS to provide the standard of care. This approach may reduce health costs and related patient migration.

【 授权许可】

CC BY