An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative day 1?

Lam, Jenny; Suzuki, Toshiaki; Bernstein, David; Zhao, Beiqun; Maeda, Carlos Toshinori; Pham, Thach Tuan; Sandler, Bryan J.; Jacobsen, Garth R.; Cheverie, Joslin; Horgan, Santiago

doi:10.1007/s00464-018-6368-9

Cited by 38 publications

(27 citation statements)

References 25 publications

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“…28 In terms of postoperative morbidity, a systematic review and meta-analysis described no or low influence on morbidity. 17 In accordance with these results, Lam et al 29 supported a shorter LOS in patients undergoing SG, without increasing 30-day perioperative morbidity (3.6%, P = .4) or readmission rates (1.2%, P = .8). Our findings are congruent with the previous reported studies, showing a decreasing trend regarding readmissions and postoperative adverse events.…”

Section: Outcomes Of the Implementation Of Eras Protocolsmentioning

confidence: 62%

Outcomes of Enhanced Recovery After Surgery Protocols Versus Conventional Management in Patients Undergoing Bariatric Surgery

Vico

Cheng

Bowers

et al. 2022

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Enhanced recovery after surgery (ERAS) pathways focus on decreasing surgical stress and promoting return to normal function for patients undergoing surgical procedures. The aim of our study was to evaluate the impact of an ERAS protocol on outcomes of patients undergoing primary sleeve gastrectomy and Roux-en-Y gastric bypass. Outcomes included hospital length of stay (LOS), and management of postoperative pain and postoperative nausea and vomiting (PONV) measured by pain medications and antiemetic use, respectively. Incidence of 90-day emergency department (ED) visits, readmissions, and complications were also analyzed. Methods: A retrospective review was performed from October 1, 2016 to October 31, 2018 of patients enrolled in the ERAS versus the conventional pathway. Patient baseline characteristics, pain and nausea scores, LOS, and postoperative outcome variables were collected. Results: Non-ERAS (n = 193) and ERAS (n = 173) groups had similar patient characteristics. Fewer ERAS patients required postoperative opioids and antiemetics (P < .01), with a significant difference in postoperative nausea control in favor of ERAS patients (P < .05). There was a decreasing trend in median LOS (2 versus 1, P = .28), 90-day postoperative readmissions (10.4% versus 8.1%, P = .47), and major adverse events (5.2% versus 1.7%, P = .07) after ERAS implementation. The ED visits and postoperative need for intravenous fluid for dehydration were significantly lower in the ERAS group (P = .01). Conclusion: Implementation of ERAS pathway for bariatric surgery was associated with less opioid usage, PONV, ED visits, and postoperative need for intravenous fluids, without increasing LOS, 90-day readmission or rates of adverse effects.

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Section: Outcomes Of the Implementation Of Eras Protocolsmentioning

confidence: 62%

Outcomes of Enhanced Recovery After Surgery Protocols Versus Conventional Management in Patients Undergoing Bariatric Surgery

Vico

Cheng

Bowers

et al. 2022

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…With improved understanding of optimal patient recovery after surgery and the advent of enhanced recovery after surgery (ERAS), many patients are now going home within 2 to 3 days following bariatric surgery [ 35 , 36 ]. A meta-analysis looking at the length of stay following bariatric surgery in ERAS and non-ERAS cohorts demonstrated a mean length of stay of 2.8 days for the ERAS group.…”

Section: Discussionmentioning

confidence: 99%

Characterizing Timing of Postoperative Complications Following Elective Roux-en-Y gastric Bypass and Sleeve Gastrectomy

et al. 2021

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Purpose With the growing prevalence of bariatric procedures performed worldwide, it is important to understand the timing of postoperative complications following bariatric surgery and the differences which may exist between procedures. Methods This retrospective study was conducted using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2017 to 2018. All patients with primary elective Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures were included. The primary outcome was to characterize the timing of postoperative complications for RYGB and SG. Results A total of 316,314 patients were identified with 237,066 (74.9%) in the SG cohort and 79,248 (25.1%) in the RYGB cohort. Early complications included myocardial infarction (4.7 ± 6.4 days), cardiac arrest (6.4 ± 8.5 days), pneumonia (6.9 ± 6.9 days), progressive renal insufficiency (8.1 ± 8.1 days), and acute renal failure (8.2 ± 7.6 days). Late complications included Clostridioides difficile infection (11.3 ± 7.8 days), organ space infections (11.7 ± 7.9 days), deep incisional infections (12.4 ± 6.6 days), superficial incisional infections (13.2 ± 6.9 days), and urinary tract infections (14.0 ± 8.4 days). SG patients were more likely to be diagnosed later than RYGB patients with regard to superficial incisional infections (14.0 ± 7.4 days vs 12.5 ± 6.3 days; p = 0.002), organ space infections (12.6 ± 7.8 days vs 10.8 ± 7.9 days; p = 0.001), acute renal failure (9.3 ± 8.1 days vs 6.8 ± 6.8 days; p = 0.03), and pulmonary embolism (13.7 ± 7.5 days vs 11.3 ± 8.0 days; p = 0.003). No significant difference in timing was observed for any other complication by procedures. Conclusion We demonstrate that significant differences in timing exist between complications and that these differences also vary by surgical procedure. Graphical abstract

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“…In recent years, there has been a growing interest in the ERAS protocol applied to BMS, although there is a need of raising awareness, implementation, and standardization of the protocol, with a multimodal, simple, efficient, and cost-effective approach in the care of bariatric patients [30]. Aktimur et al [31] showed significant reduction in the LOS of bariatric surgery patients.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) protocol in bariatric and metabolic surgery (BMS)—analysis of practices in nutritional aspects from five continents

et al. 2020

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This study aims to understand the prevalent practices on the nutritional aspects of the enhanced recovery after surgery (ERAS) protocol based on the knowledge and practice of surgeons, nutritionists, and anesthesiologists who work in the bariatric and metabolic surgery (BMS) units worldwide. This cross-sectional study enrolled BMS unit professionals from five continents-Africa, America, Asia, Europe, and Oceania. An electronic questionnaire developed by the researchers was provided to evaluate practices about the three nutritional aspects of ERAS protocol in BMS (Thorel et al. 2016): preoperative fasting, carbohydrate loading, and early postoperative nutrition. Only surgeons, nutritionists, and anesthesiologists were invited to participate. One hundred twenty-five professionals answered the questionnaires: 50.4% from America and 39.2% from Europe. The profile of participating professionals was bariatric surgeons 70.2%, nutritionists 26.4%, and anesthesiologists 3.3%. Approximately 47.9% of professionals work in private services, for about 11 to 20 years (48.7%). In all continents, a large majority were aware of the protocol. Professionals from the African continent reported having implemented the ERAS bariatric protocol 4.0 ± 0 years ago. It is worth mentioning that professionals from the five continents implemented the ERAS protocol based on the published literature (p = 0.012). About preoperative fasting abbreviation protocol, a significant difference was found between continents and consequently between services (p = 0.000). There is no uniformity in the conduct of shortening of fasting in the preoperative period and the immediate postoperative period. Early postoperative (PO) period protein supplementation is not performed in a standard fashion in all units globally. ERAS principles and practices are partial and insufficiently implemented on the five continents despite the prevalent knowledge of professionals based on evidence. Moreover, there is no uniformity in fasting, immediate postoperative diet, and early protein supplementation practices globally.

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An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative day 1?

Abstract: A cost-effective ERAS protocol for laparoscopic sleeve gastrectomy results in shorter length of stay, without increase in peri-operative morbidity or readmission rates.

Cited by 38 publications

References 25 publications

Outcomes of Enhanced Recovery After Surgery Protocols Versus Conventional Management in Patients Undergoing Bariatric Surgery

Outcomes of Enhanced Recovery After Surgery Protocols Versus Conventional Management in Patients Undergoing Bariatric Surgery

Characterizing Timing of Postoperative Complications Following Elective Roux-en-Y gastric Bypass and Sleeve Gastrectomy

Enhanced Recovery After Surgery (ERAS) protocol in bariatric and metabolic surgery (BMS)—analysis of practices in nutritional aspects from five continents

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