A randomized controlled trial of an enhanced recovery after surgery protocol in patients undergoing laparoscopic sleeve gastrectomy

Papasavas, Pavlos; Seip, Richard L.; McLaughlin, Tara; Staff, Ilene; Thompson, Stephen; Mogor, Ifeoma; Sweeney, Jane K.; Gannon, Richard; Waberski, Witold; Tishler, Darren

doi:10.1007/s00464-022-09512-3

Cited by 8 publications

(26 citation statements)

References 18 publications

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“…Of the eight articles removed, two were reviews, five had no control group, and one lacked related data. Finally, 21 full-text articles 15 – 35 involving 10 764 patients were included, of whom 6449 (59.91%) were in the ERAS group and 4315 (40.09%) in the SC group. Figure 1 describes the PRISMA flow diagram of the literature selection process.…”

Section: Resultsmentioning

confidence: 99%

“…All trials comparing the efficacy of the ERAS protocol with that of SC in patients undergoing minimally invasive bariatric surgery were well designed. Of the 21 studies, eight 15 , 17 , 22 , 27 , 28 , 30 , 32 , 35 were related to laparoscopic SG, three 16 , 21 , 25 were related to laparoscopic RYGB, and 10 18 – 20 , 23 , 24 , 26 , 29 , 31 , 33 , 34 were associated with laparoscopic SG + laparoscopic RYGB. Six were RCTs 15 , 17 , 21 , 25 , 28 , 35 , and the remaining 15 16 , 18 – 20 , 22 – 24 , 26 , 27 , 29 – 34 were retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…However, many recommendations for this implementation are extrapolated from other surgery types, with relatively low quality of evidence 13 , 14 . Several studies 15 – 35 have yielded inconsistent outcomes after assessing the effectiveness of this multimodal care protocol in minimally invasive bariatric surgery. Therefore, the safety and usefulness of the ERAS protocol in a bariatric setting are unclear.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of enhanced recovery after surgery protocol on minimally invasive bariatric surgery: a meta-analysis

Gao

Chen

Liu

et al. 2023

International Journal of Surgery

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Background: Enhanced recovery after surgery (ERAS), a multidisciplinary and multimodal perioperative care protocol, has been widely used in several surgical fields. However, the effect of this care protocol on patients receiving minimally invasive bariatric surgery remains unclear. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent minimally invasive bariatric surgery. Material and methods: PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify literature reporting the effects of the ERAS protocol on clinical outcomes in patients undergoing minimally invasive bariatric surgery. All the articles published until 01 October 2022, were searched, followed by data extraction of the included literature and independent quality assessment. Then, pooled mean difference (MD) and odds ratio with a 95% CI were calculated by either a random-effects or fixed-effects model. Results: Overall, 21 studies involving 10 764 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (MD: −1.02, 95% CI: −1.41 to −0.64, P<0.00001), hospitalization costs (MD: −678.50, 95% CI: −1196.39 to −160.60, P=0.01), and the incidence of 30-day readmission (odds ratio =0.78, 95% CI: 0.63–0.97, P=0.02) were significantly reduced. The incidences of overall complications, major complications (Clavien–Dindo grade ≥3), postoperative nausea and vomiting, intra-abdominal bleeding, anastomotic leak, incisional infection, reoperation, and mortality did not differ significantly between the ERAS and SC groups. Conclusions: The current meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving minimally invasive bariatric surgery. Compared with SC, this protocol leads to significantly shorter hospitalization lengths, lower 30-day readmission rate, and hospitalization costs. However, no differences were observed in postoperative complications and mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of enhanced recovery after surgery protocol on minimally invasive bariatric surgery: a meta-analysis

Gao

Chen

Liu

et al. 2023

International Journal of Surgery

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“…Thus, there was no sample size determination. The sample size in this study reflects the sample size that was calculated for the RCT testing the effect of an ERAS protocol on recovery from sleeve gastrectomy (mentioned above), in which participants in the present study were initially enrolled [9, 12]. In that trial, the sample size estimate was based on detection of the effect size for functional length of stay (i.e., hours from surgery close to attainment of RFD5).…”

Section: Methodsmentioning

confidence: 99%

Utility of a Novel Scale to Assess Readiness for Discharge After Bariatric Surgery

et al. 2021

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Background The safe release of a patient from hospital care after bariatric surgery depends upon the achievement of satisfactory health status. Here, we describe a new objective scale (the Readiness for Discharge, RFD Scale) to measure the patient's suitability for hospital discharge after bariatric surgery. Methods We conducted a retrospective, observational analysis of data collected in a randomized clinical trial of an enhanced recovery after surgery protocol for laparoscopic sleeve gastrectomy from 3/15/2018 to 1/12/2019. Nursing staff assessed 122 patients every 4-8 h after surgery using a checklist to document 5 components: ambulation, vital signs, pain, nausea, and oral intake of clear fluid. Satisfaction of each component was scored as ''1'' (satisfactory) or ''0'' (not satisfactory). Scores were summed and analyzed for patterns. RFD = 5 marked the patient as ready for discharge.Results Sufficient intake of clear liquid was the last RFD component satisfied in 87% of patients. Two overall response patterns emerged: '' Steady Progressors'' (n = 51) whose RFD score rose steadily from 0 to 5 without reversion to a lower score; and ''Oscillators'' (n = 71) who had at least one temporary decrease in RFD score on the way to attaining 5, or showed a simultaneous oscillation of components without change in RFD. Conclusions The RFD checklist allows objective scoring of medical readiness for discharge after LSG and has the potential to improve clinical communication.

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“…Its clinical pathway spans the entire diagnostic and treatment process, including pre-hospitalization, preoperative, intraoperative, postoperative, and post-discharge phases [ 5 ]. Based on previous studies, the adoption of the ERAS concept can significantly enhance the efficiency of surgical patient care, accelerate patient recovery, and improve postoperative quality of life [ 6 – 8 ]. In recent years, exploring other adjuvant treatment measures has become a hot topic and focus in clinical research.…”

Section: Introductionmentioning

confidence: 99%

Clinical study of electroacupuncture on the recovery of gastrointestinal dysfunction after laparoscopic surgery for gastrointestinal cancer - study protocol for a randomized controlled trial

Chung,

Li,

Wang

et al. 2024

BMC Complement Med Ther

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Background Gastrointestinal dysfunction is one of the common complaints for patient post-surgery. Acupuncture has been employed to improve gastrointestinal function and sleeping quality and has confirmed clinical efficacy for emotional problems. This study aims to evaluate the clinical effect of electroacupuncture for postoperative rapid recovery. Methods This study design is a two-arm, parallel, double-blinded randomized controlled trial. 104 subjects, aged from 40 to 89 years old, diagnosed with gastrointestinal cancer undergoing laparoscopic surgery, will be divided into Interventional Group and Control Group. Patients of both groups receive perioperative care under the guidance of ERAS guidance. The Interventional Group receives electroacupuncture treatment starting from the first day post-surgery for a consecutive 5 days, whereas the Control Group receives placebo electroacupuncture treatment. The primary outcome will be the first flatus time whereas the secondary outcomes will be the first sign of borborygmus, recovery of defecation, laboratory tests and questionnaires including Self-rating anxiety scale, Ford Insomnia Response to Stress Test, TCM rating scale of Gastrointestinal symptoms and Gastrointestinal Symptoms Rating Scales. Discussion This study aims to provide timely intervention for post-laparoscopic patients with gastrointestinal tumour using the ERAS concept combined with electroacupuncture, observe the efficacy of this therapy in treating PGID, and contribute reliable scientific evidence for postoperative rapid recovery. Trial registration Chictr.org.cn Identifier: ChiCTR2300078710. Registered on 15th December 2023.

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A randomized controlled trial of an enhanced recovery after surgery protocol in patients undergoing laparoscopic sleeve gastrectomy

Cited by 8 publications

References 18 publications

Efficacy and safety of enhanced recovery after surgery protocol on minimally invasive bariatric surgery: a meta-analysis

Efficacy and safety of enhanced recovery after surgery protocol on minimally invasive bariatric surgery: a meta-analysis

Utility of a Novel Scale to Assess Readiness for Discharge After Bariatric Surgery

Clinical study of electroacupuncture on the recovery of gastrointestinal dysfunction after laparoscopic surgery for gastrointestinal cancer - study protocol for a randomized controlled trial

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