Initial result of unselective implementation of enhanced recovery after surgery in a low-volume bariatric unit: a feasibility and safety study

Abstract

Background The feasibility and safety of unselectively applying an enhanced recovery after surgery (ERAS) protocol in a low-volume bariatric unit were determined.Material and methods We retrospectively reviewed all patients undergoing bariatric surgeries under a single surgeon between January 2015 and December 2018. Our ERAS protocol initiated in January 2017 with all patients enrolled unselectively. For those receiving non-primary procedures or with BMI < 32.5 kg/m2 were excluded from this analysis. Demographic features and all 30-day outcome measures, including operation time, length of stay (LOS), ER visits, readmissions, reoperations were collected and compared between the ERAS (2017–2018) and control (2015–2016) groups.Results One hundred eighty-four consecutive patients underwent bariatric surgeries during the study period. Of those fulfilling the inclusion criteria, 62 (40.8%) were treated before and 90 (59.2%) were treated after ERAS implementation. No differences in baseline demographics were found between the groups except ERAS group had more Roux-en-Y gastric bypass procedures (58.9% vs. 12.9%). A markedly reduced operation time (101 min vs. 147 min; p < 0.001) and shortened LOS (2.6 days vs. 3.3 days; p < 0.001) were observed, with significantly more ERAS patients achieving POD1 discharge (45.6% vs. 1.6%; p < 0.001). There were no significant differences in terms of ER visits (2.2% vs. 8%), readmissions (1.1% vs. 4.8%) or total complication rates between the groups (5.5% vs. 9.7%).Conclusion Unselective ERAS implementation in low-volume units is feasible and safe, with significantly reduced operation times and a shortened LOS without increased complications.