Results of Implementing an Enhanced Recovery After Bariatric Surgery (ERABS) Protocol

Mannaerts, Guido H. H.; Mil, Stefanie R. van; Stepaniak, Pieter S.; Dunkelgrün, Martin; Quelerij, Marcel de; Verbrugge, Serge; Zengerink, Hans F.; Biter, L. Ulas

doi:10.1007/s11695-015-1742-3

Cited by 92 publications

(59 citation statements)

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“…In the present study, the decrease in FHS in the ERAS group was 3 h, which was less than expected and less than that found in other studies 25,26 . This outcome could be explained by the finding that patients in the conventional care group had an unexpectedly short FHS of 20⋅5 h. A possible explanation for this might be that a fast-track programme was already in place at this centre from 2011 18 .…”

Section: Discussioncontrasting

confidence: 93%

Randomized clinical trial of an enhanced recovery after surgery programmeversusconventional care in laparoscopic Roux‐en‐Y gastric bypass surgery

et al. 2019

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Background Enhanced recovery after surgery (ERAS) programmes have led to a decreased duration of hospital stay in several surgical fields, but have not been fully tested in patients undergoing laparoscopic Roux‐en‐ gastric bypass (LRYGB) for obesity. This study aimed to investigate an ERAS programme versus standard care in these patients. Methods Between January 2013 and July 2014, patients undergoing LRYGB were randomized to ERAS or conventional care. The primary outcome was functional hospital stay, defined as the time between end of surgery and when predefined discharge criteria (pain adequately controlled, fever and postoperative nausea and vomiting (PONV) absent, full liquid diet tolerated, mobilized and feeling fit for discharge) were met. Secondary outcomes were total length of hospital stay, 30‐day complication and mortality rates, duration of surgery, time spent on the recovery ward and health‐related quality of life. Results A total 220 patients were randomized to ERAS (110 patients) or conventional (110) care. Patients in the ERAS group had shorter functional hospital stay (17·4 versus 20·5 h; P < 0·001), quicker pain control, tolerated liquid diet earlier, had earlier control of PONV, mobilized sooner and were comfortable with discharge sooner than those receiving conventional care. Total length of hospital stay, duration of surgery, time spent on the recovery ward, health‐related quality of life, complication and readmission rates did not differ between the study groups. There were no deaths. Conclusion Patients under ERAS care recovered faster after LRYGB surgery than those receiving conventional care, with no increase in readmission and postoperative morbidity rates. Registration number: NTR3853 ( http://www.trialregister.nl/ ).

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Section: Discussioncontrasting

confidence: 93%

Randomized clinical trial of an enhanced recovery after surgery programmeversusconventional care in laparoscopic Roux‐en‐Y gastric bypass surgery

et al. 2019

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“…Secondary outcome measures were overall morbidity and specific complication rates (bleeding, leakage, cardiopulmonary), mortality and readmissions. Since the Clavien-Dindo (CD) classification was present in five papers, it was used as the primary complication classification [9, 11, 12, 14, 18, 19]. Complications were classified as minor for grade 1 and grade 2 in CD.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2016

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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.

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“…In addition to an Enhanced Recovery after Bariatric Surgery (ERABS) protocol our current standardized anesthetic regimen in Bariatric surgery has been extensively described elsewhere [5]. In short, it is based on a couple of pillars.…”

Section: Abstract: Bariatric Surgery; Anesthesia; Complications; Protmentioning

confidence: 99%

“…In table 1 we have shown the number of uncomplicated endoscopic gastric [ 10] (Table 1) [5]. This was achieved without a difference in the amount of anesthesia related complications.…”

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confidence: 99%

Anesthesia in Bariatric Surgery: The Twelve Labors of Hercules?

Quelerij¹,

Verbrugge²

2015

JGPLD

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relaxation rocuroniumbromide antagonized with sugammadex at the end of the operation [7]. While others endorse the use of dexmedetomidine and avoidance of opioids in this patient group [8], 8) we have good experience with regular opioids and ketamine after induction of anesthesia; 9) in the recovery room we titrate regular opioids combined with clonidine, meperidine and intravenous acetaminophen to a VAS score of < 4 before the patient is dismissed from the recovery room. 10) We give little if any opioids on the wards where 11) the main pillar of ERABS is early mobilization within 2 hours postoperatively under the supervision of a physiotherapist.When we began with bariatric surgery in our hospital we used to admit patients with identified risk factors (such as e.g. the superobese (BMI > 50), documented sleep apneas with CPAP, difficult to regulate diabetes and documented pulmonary hypertension) to the ICU for a 24 hours postoperative surveillance. We found however, 12) that admittance to the ICU has no additional value and does only result in late mobilization and may thereby increase the risk of thromboembolism [9]. (Table 1) [5]. This was achieved without a difference in the amount of anesthesia related complications.In summary, the anesthesiologist does not have to introduce Herculean measures to properly care for the bariatric patient. Airway and ventilatory management is not the Nemian lion where properly prepared; pharmacokinetics and dynamics using a standard protocol are not as mystical as the Stymphalian birds and peri operative care and organization do not represent an Ermanthian Boar if the key strategy is early mobilization of the patient. Keywords: Bariatric surgery; Anesthesia; Complications; ProtocolIn Greek mythology, the twelve labors refer to a series of tasks carried out by Hercules, the greatest of Greek heroes, accomplished over a twelve year period [1,2]. Anesthetizing bariatric patients may unfairly feel like Herculean penances to the anesthesiologist. In this short editorial, we want to summarize what we have learned from a 12 year (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) anesthetic experience with this category of patients in our teaching hospital, specified to uncomplicated endoscopic gastric sleeve-and bypass procedures and how we feel anesthesia should be performed in this group.Numerous peri-operative anesthetic problems related to bariatric surgical patients have been described and include e.g. 1) difficult to control diabetes, 2) asthma, 3) unhealthy lifestyle and smoking habits [3], 4) sleep apnea, 5) cardiac problems, 6) difficulties with mask ventilation and 7) intubation, 8) ventilatory problems, 9) uncertainty about the exact pharmacokinetics and 10) Pharmacodynamics, 11) risk of thromboembolic complications and 12) the risk of postoperative airway obstruction when opioids are given to this group of patients [4].In addition to an Enhanced Recovery after Bariatric Surgery (ERABS) protocol our current standardized anesthetic regimen in Bariatric...

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Results of Implementing an Enhanced Recovery After Bariatric Surgery (ERABS) Protocol

Cited by 92 publications

References 50 publications

Randomized clinical trial of an enhanced recovery after surgery programmeversusconventional care in laparoscopic Roux‐en‐Y gastric bypass surgery

Randomized clinical trial of an enhanced recovery after surgery programmeversusconventional care in laparoscopic Roux‐en‐Y gastric bypass surgery

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

Anesthesia in Bariatric Surgery: The Twelve Labors of Hercules?

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