Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis

Abstract

Enhanced recovery after surgery (ERAS) protocol is well established in many surgical disciplines and leads to a decrease in the length of hospital stay and morbidity. Multimodal protocols have also been introduced to bariatric surgery. This review aims to evaluate the current literature on ERAS in obesity surgery and to conduct a meta-analysis of primary and secondary outcomes. MEDLINE, Embase, Scopus and Cochrane Library were searched for eligible studies. Key journals were hand-searched. We analysed data up to May 2016. Eligible studies had to contain four described ERAS protocol elements. The primary outcome was the length of hospital stay; the secondary outcomes included overall morbidity, specific complications, mortality, readmissions and costs. Random effect meta-analyses were undertaken. The initial search yielded 1151 articles. Thorough evaluation resulted in 11 papers, which were analysed. The meta-analysis of the length of stay presented a significant reduction standard mean difference (Std. MD) = −2.39 (−3.89, −0.89), p = 0.002. The analysis of overall morbidity, specific complications and Clavien-Dindo classification showed no significant variations among the study groups. ERAS protocol in bariatric surgery leads to the reduction of the length of hospital stay while maintaining no or low influence on morbidity.

Comparison of circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: a multicenter study.

“…Numerous studies have demonstrated that application of the ERAS protocol is associated with significant shortening of LOS [27]. …”

Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: A prospective randomized controlled trial

“…Several studies and meta-analyses have shown that patients obtained many benefits such as less pain, earlier intestinal function recovery, shorter hospital stay, less medical expenses, and higher medical satisfaction by implementing the ERAS programs. [9][10][11][12] To provide further evidence for effectiveness of ERAS programs in hepatectomy, a RCT was carried out to compare the perioperative effects between ERAS group and CS group in patients undergoing hepatectomy. The study was approved by the ethics committee of the First Affiliated Hospital of University of South China.…”

Racial Disparities in Bariatric Surgery Complications and Mortality Using the MBSAQIP Data Registry

“…These conflicting findings highlight the complexity of the topic and prospective studies are needed to better understand patient and surgeon decision making, develop standardized management plans, and to assess the impact of interventions. Enhanced recovery pathways have demonstrated significant improvements in perioperative care by standardizing care [56] and adoption of standardized protocols may help reduce underlying implicit bias that can result in outcome disparities [57,58].…”