Obesity surgery: 73 percent of those who undergo surgery are women. The analysis of the Italian phenomenon and the new protocol with short hospitalizations

If there wasn't theobesity, second cause of global deathwe would have 12% fewer tumors in men and 13.5% fewer tumors in women.
Obesity is one of the most widespread conditions in the world, including in our country, where almost half of Italians are overweight And one in ten (10%) clinically obese. Significant numbers, which are widely highlighted again these days, on the occasion of the 32nd National Congress of Sicob (Italian Society of Obesity Surgery) in Giardini Naxos.

Identikit of those who operate in Italy

The new data released by SICOB and relating to 2023, collected at the 135 official centers (66 in the North, 28 in the Centre, 28 in the South and 13 in the Islands), reveal that in Italy 73% of patients operated on for obesity are women and a third of the sample has aaged between 41 and 50 years.

There were 26624 interventions in total and 14424 were concentrated in Northern Italy (54%), 5407 in the South (20%), 4613 in the Center (18%) and 2180 in the Islands (8%). In detail, the region with the greatest number of interventions is Lombardy (8189), followed by Campania (3679) and Emilia Romagna (3428). Scrolling through the ranking, we find Lazio (1975), Sicily (1700), Puglia (1498), Abruzzo (1294), Veneto (1202) and Tuscany (1004). In the second part of the list, Piedmont (672), Sardinia (480), Liguria (398), Friuli Venezia Giulia (386), Marche (199), Umbria (129). Bringing up the rear are Trentino Alto Adige and Basilicata (both with 121), Calabria (109), Valle d'Aosta (28) and Molise (12).

As regards the type of intervention, in addition to the 97% conducted laparoscopically or robotically, there Sleeve Gastrectomy (14149) – a intervention that acts reducing hunger and increasing satiety – represents 53% of the procedures carried out; to follow, the traditional gastric bypass (3767-14%), the minigastric bypass (3538-13%) and endoscopic procedures (2605-10%).

Operation management: a new protocol

In addition to taking stock of the state of bariatric surgery, the Congress is an opportunity to propose and disseminate a new protocol for the perioperative management of the obese patient, already adopted at some accredited centres.
This protocol allows a rapid post-operative recovery of the patient undergoing surgery through the application of a multimodal path aimed at reducing stress, pain, nausea, vomiting in the absence of tubes, drainage and catheters. The application of this protocol ensures a better patient experience and short-term hospitalizations, as well as an almost immediate recovery.
«By widely applying protocols that allow a reduction in postoperative hospital stay, it is possible to go from 5 days of traditional management to around 2 of the new approach while maintaining quality and safety unchanged», he explains Giuseppe Navarra, President Sicob. «This therefore allows us to optimize the use of beds by doubling the number of patients who can be operated on».

ERAS is the acronym that globally identifies this new approach proposed and adapted to the Italian reality, so that it can be shared by SICOB members and then introduced widely across the national territory. The Company will be responsible for verifying the adoption of the protocols at the level of the individual centers which can then be accredited.

What happens before the operation

In the phase preoperative it is central counseling, a phase in which the patient is instructed on all the stages of his journey, so as to reduce his anxiety and increase his awareness. As far as the intervention is concerned, they are chosen minimally invasive approachesthrough laparoscopic and robotic surgerytherefore without cuts but only with very slight incisions. The role of the anesthesiologist is fundamental and will follow anesthetic protocols that limit the use of opiates to a minimum, reducing the risk of post-operative nausea, pain and vomiting.

What happens after the surgery

By adopting the proposed measures, the phase postoperative it has less impact and consequently the patient can leave the hospital sooner. «Waking up is almost immediate at the end of the operation, the patient is able to leave the bed, sip liquids and resume minimal nutrition after a few hours and can return home within 48 hours rather than after 4-5 days typical of classic management”, he specifies Navarre. «Except in particular cases, tubes, drains and catheters are no longer used. However, discharge occurs only after a scrupulous examination and the completion of a specific and detailed check list. Reduction of hospitalization from 5 to 2 days also means saving resources on the one hand, but above all beds available for other patients and interventions”.

The advantages of a reduced hospital stay

The adoption of the new protocol allows surgery to be made gentler. Furthermore, it puts patients at the centre, returning them to their daily lives quickly and in good conditions.
«The results leave everyone very satisfied: reduced complications, therefore full safety, but also an increase in the quality perceived by the patient», he explains Giuseppe Maria Marinari head of U.Op. Bariatric Surgery at the IRCCS Humanitas in Milan, whose fruitful experience with fast track perioperative management protocols in bariatrics dates back to 2013. «We can talk without fear about the humanization of care. It should not be forgotten that hospital managers are also satisfied: these protocols increase the sustainability of surgery, essentially allowing more people to be treated with the same resources in terms of hospital beds. To obtain these results it is necessary to work on four fronts: creation of an efficient and effective team (collaboration with anesthetists and nurses is essential), great attention to pre-operative preparation in order to reduce the risk of complications, conviction in abandoning some traditions passed on to us by our teachers, follow the patient even after discharge.”