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Enhanced Recovery Protocol for Laparoscopic Sleeve Gastrectomy: Are Narcotics Necessary?

  • Richard S. HoehnEmail author
  • Aaron P. Seitz
  • Kathleen E. Singer
  • Jonathan R. Thompson
  • Brad M. Watkins
Original Article

Abstract

Background

Enhanced recovery after surgery (ERAS) protocols have improved patient experience and outcomes in a variety of fields, including bariatric surgery. Given the increasing opioid epidemic in the USA, we sought to determine the impact of our own ERAS protocol on narcotic usage following laparoscopic sleeve gastrectomy.

Methods

Retrospective chart review was performed on patients undergoing primary laparoscopic sleeve gastrectomy for 6 months before and after implementation of an ERAS protocol. Our protocol strongly discouraged the use of narcotics in the postoperative period. Specific outcomes of interest were postoperative narcotic usage, length of stay, complications, and readmissions.

Results

Patient characteristics were similar in the two groups. ERAS implementation did not correlate with changes in length of stay, complications, or readmissions. However, ERAS implementation was associated with dramatic reductions in the use of intravenous narcotics (100% vs 47%, p < 0.01) and oral schedule 2 narcotics (56% vs 6%, p < 0.01), with an increase in the usage of tramadol (0% vs 36%, p < 0.01). After ERAS implementation, 52% of patients were managed without the use of schedule 2 narcotics (0% pre-ERAS, p < 0.01) and 33% received no narcotics of any kind (0% pre-ERAS, p < 0.01).

Conclusion

Implementation of an ERAS protocol for laparoscopic sleeve gastrectomy is associated with a dramatic reduction in the use of narcotics in the postoperative period. This has implementation for the usage of narcotics for laparoscopic surgery and potential elimination of narcotics for certain patients and procedures.

Keywords

Narcotic Opioid Enhanced recovery after surgery ERAS Sleeve gastrectomy Bariatric surgery Minimally invasive surgery 

Notes

Acknowledgements

The authors would like to acknowledge Kristina Arnold for her assistance with data acquisition and Koffi Wima for his assistance with data analysis.

Author Contributions

RH designed the study and drafted the manuscript; RH, AS, and KS acquired the data; all authors interpreted the data, revised the manuscript, gave final approval of the manuscript, and are accountable for the work and its integrity.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Cincinnati College of MedicineCincinnatiUSA

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