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

Abstract

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.

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

“…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.…”

Perioperative Pain Management in Bariatric Anesthesia

“…[ 1 2 ] Additionally, certain patients have pre-existing risk factors for poorly controlled acute pain - chronic pain, chronic opioid use, substance abuse, complex psychiatric history, or previous experience of poorly controlled pain [ Table 1 ]. [ 9 10 11 12 13 14 ] These subsets of patients often have a perioperative escalation of their opioid requirements and hence should be meticulously screened and tested for OSA. Many of these patients will need specialist consultations for their pain before elective surgery and plan for extended postoperative stay with appropriate level and duration of monitoring.…”

“…The evidence thus far supports preoperative education and prehabilitation, implementation of ERAS programs, and the use of structured pain management protocols. [ 9 10 11 12 13 14 ] Therefore, perioperative pain-related interventions have benefits beyond early discharge and enhanced recovery. We believe that this focus on long-term reductions in pain and persistent opioid use will allow for these patients to achieve all the benefits of undergoing weight loss surgery.…”

The transit of oral premedication beyond the stomach in patients undergoing laparoscopic sleeve gastrectomy: a retrospective observational multicentre study

“…Furthermore, it improves obesity-related and non-obesity-related diseases such as cardiovascular disease, type 2 diabetes and stroke, non-alcoholic fatty liver, obstructive sleep apnea, and urinary incontinence [ 1 – 6 ]. The implementation of enhanced recovery after bariatric surgery (ERABS) is a proven model for accelerating patient recovery without compromising the length of hospital stay, 90-day readmission, or adverse events [ 7 , 8 ].…”