Enhanced Recovery After Surgery Protocol in Bariatric Surgery Leads to Decreased Complications and Shorter Length of Stay

Fair, Lucas; Leeds, Steven G.; Whitfield, Edward P; Bokhari, Syed Harris; Rasmussen, Madeline L; Hasan, Syed; Davis, Daniel G.; Arnold, David; Ogola, Gerald; Ward, Marc A.

doi:10.1007/s11695-023-06474-w

Cited by 9 publications

(3 citation statements)

References 27 publications

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“…In the current study, the mean hospital stay was approximately 3.5 days in both groups. While some centers report mean hospital stays of one or two nights, there have also been studies reporting similar hospital stays to our findings [ 22 ]. Routine intra-abdominal drain use after sleeve gastrectomy is reported to be approximately 35% [ 23 ].…”

Section: Discussionsupporting

confidence: 85%

Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study

Kavakli,

Sahin,

Koc

et al. 2024

OBES SURG

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Purpose The external oblique intercostal plane (EOI) block is a novel block technique for anterolateral upper abdominal wall analgesia. The superficial nature of the external oblique intercostal plane allows it to be easily identified even in patients with obesity. The aim of this study was to test the hypothesis that EOI block would reduce IV morphine consumption within 24 h after laparoscopic sleeve gastrectomy. Materials and Methods Patients were randomly assigned to one of two groups: EOI block group and control group. The patients in the EOI block group received ultrasound-guided bilateral EOI block with a total of 40 ml 0.25% bupivacaine after anesthesia induction. The patients in the control group received no intervention. Postoperatively, all the patients were connected to an intravenous patient controlled analgesia (PCA) device containing morphine. The primary outcome of the study was IV morphine consumption in the first postoperative 24 h. Results The median [interquartile range] morphine consumption at 24 h postoperatively was significantly lower in the EOI block group than in the control group (7.5 [3.5 to 8.5] mg vs 14 [12 to 20] mg, p = 0.0001, respectively). Numerical rating scale (NRS) scores at rest and during movement were lower in the EOI block group than in the control group at 2, 6, and 12 h but were similar at 24 h. No block-related complications were observed in any patients. Conclusion The results of the current study demonstrated that bilateral EOI block reduced postoperative opioid consumption and postoperative pain in patients with obesity undergoing laparoscopic sleeve gastrectomy. Trial Registration Clinicaltrials.gov identifier: NCT05663658. Graphical Abstract

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Section: Discussionsupporting

confidence: 85%

Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study

Kavakli,

Sahin,

Koc

et al. 2024

OBES SURG

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“…ERAS protocols aim to restore a patient's physiological status following surgery and expedite functional recovery. Following the introduction of ERAS and recent updated guidelines in BMS, 6,7 several studies have shown an overall improvement in patient outcomes with fewer reported complications and reduction in length of hospital stay 15 . However, there is currently limited evidence of the use of ERAS for patients undergoing BMS, particularly in the United Kingdom.…”

Section: Discussionmentioning

confidence: 99%

The need for standardized perioperative care for patients undergoing bariatric and metabolic surgery in the United Kingdom

Lee,

Courtney

2024

Clinical Obesity

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SummaryEnhanced recovery after surgery (ERAS) protocols are shown to improve patient outcomes and reduce length of hospital stay. However, there is currently limited consensus on the perioperative management of patients undergoing bariatric and metabolic surgery (BMS) in the United Kingdom. This study aims to survey the level of consistency in patient care undergoing BMS. Bariatric nurse specialists from 30 bariatric units completed an anonymised, online survey from 21 December 2022 to 21 February 2023. Most units (77%) have implemented a premade postoperative care bundle protocol including predetermined timing of oral intake (77%) and postoperative day 1 bloods (60%). 63% of units have also established pre‐set analgesia and anti‐emetic bundles. Date of discharge is variable, ranging from 1 day after surgery (50%) to a ‘two night stay’ protocol (33%) to within 4 days after surgery (17%). Most follow‐up clinics are either led by dietitians (33%) or both bariatric nurse specialists and dietitians collaboratively (57%). Patients are usually established on solid food 6 weeks after surgery in 53% (16/30) units. Chemical venous thromboembolism (VTE) prophylaxis was either given on day of surgery postoperatively (60%), day before (20%) or after (17%) surgery. Our study shows significant variability of care throughout the surgical pathway, in the study population. The results suggest a need for consensus guidelines outlining the best‐practice approach to managing patients undergoing BMS; due to the heterogeneity of the patient group, these guidelines should contain overarching generalisable recommendations that can then be tailored to individual patients.

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“…Enhanced recovery after surgery (ERAS) protocols are an evidence-based care improvement process for surgical patients which have been designed to negate the impact of the anticipated physiological and immunological cascade patients are subject to following major surgery [ 20 ]. ERAS protocols have been associated with reduced post-operative complications, inpatient hospitalisation duration, and hospital costs [ 20 , 21 ]. Following the robust implementation and success of ERAS protocols in other surgical specialities (including thoracic [ 22 ], urological [ 23 ], and colorectal surgeries [ 24 ]), ERAS protocols have now been incorporated into the management paradigm for patients undergoing bariatric surgery, with results from observational and randomised clinical trial (RCT) data suggesting there may be benefit in postoperative outcomes expected following effective ERAS implementation [ 25 – 28 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Impact of Enhanced Recovery After Surgery Protocols on Surgical Outcomes Following Bariatric Surgery—A Systematic Review and Meta-analysis of Randomised Clinical Trials

Davey,

Donlon,

Fearon

et al. 2024

OBES SURG

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Background Enhanced recovery after surgery (ERAS) programmes are evidence-based care improvement processes for surgical patients, which are designed to decrease the impact the anticipated negative physiological cascades following surgery. Aim To perform a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the impact of ERAS protocols on outcomes following bariatric surgery compared to standard care (SC). Methods A systematic review was performed in accordance with PRISMA guidelines. Meta-analysis was performed using Review Manager version 5.4 Results Six RCTs including 740 patients were included. The mean age was 40.2 years, and mean body mass index was 44.1 kg/m2. Overall, 54.1% underwent Roux-en-Y gastric bypass surgery (400/740) and 45.9% sleeve gastrectomy (340/700). Overall, patients randomised to ERAS programmes had a significant reduction in nausea and vomiting (odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19–0.95, P = 0.040), intraoperative time (mean difference (MD): 5.40, 95% CI: 3.05–7.77, P < 0.001), time to mobilisation (MD: − 7.78, 95% CI: − 5.46 to − 2.10, P < 0.001), intensive care unit stay (ICUS) (MD: 0.70, 95% CI: 0.13–1.27, P = 0.020), total hospital stay (THS) (MD: − 0.42, 95% CI: − 0.69 to − 0.16, P = 0.002), and functional hospital stay (FHS) (MD: − 0.60, 95% CI: − 0.98 to − 0.22, P = 0.002) compared to those who received SC. Conclusion ERAS programmes reduce postoperative nausea and vomiting, intraoperative time, time to mobilisation, ICUS, THS, and FHS compared to those who received SC. Accordingly, ERAS should be implemented, where feasible, for patients indicated to undergo bariatric surgery. Trial registration International Prospective Register of Systematic Reviews (PROSPERO – CRD42023434492. Graphical Abstract

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Enhanced Recovery After Surgery Protocol in Bariatric Surgery Leads to Decreased Complications and Shorter Length of Stay

Cited by 9 publications

References 27 publications

Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study

Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study

The need for standardized perioperative care for patients undergoing bariatric and metabolic surgery in the United Kingdom

Evaluating the Impact of Enhanced Recovery After Surgery Protocols on Surgical Outcomes Following Bariatric Surgery—A Systematic Review and Meta-analysis of Randomised Clinical Trials

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