Reducing complication rates and hospital readmissions while revising the enhanced recovery after bariatric surgery (ERABS) protocol

Abstract

Background

To optimize the postoperative phase following bariatric surgery, the enhanced recovery after bariatric surgery pathway (ERABS) has been developed. The aim of ERABS is to create a care path that is as safe, efficient and patient-friendly as possible. Continuous evaluation and optimization of ERABS are important to ensure a safe treatment path and may result in better outcomes. The objective of this study was to compare the clinical outcomes of patients undergoing bariatric surgery over 2014–2017, during which the ERABS protocol was continuously evaluated and optimized.

Methods

This is a retrospective cohort study. Data were collected from patients undergoing a primary Roux-en-Y gastric bypass or sleeve gastrectomy between January 2014 and December 2017. Outcomes were early complications, unplanned hospital revisits, readmissions, duration of surgery and length of hospital stay.

Results

2889 patients underwent a primary bariatric procedure in a single center. There was a significant decrease in minor complications over the years from 7.0 to 1.9% (p < 0.001). Hospital revisit rates decreased after 2015 (p < 0.001). Readmission rates decreased over time (p < 0.001). The mean duration of surgery decreased from 52 (in 2014) to 41 (in 2017) minutes (p < 0.001). Median length of hospital stay decreased from 1.8 to 1.5 days in 2015 (p = 0.002) and remained stable since.

Conclusion

An improvement of the ERABS protocol was associated with a decrease in minor complication rates, number of unplanned hospital revisits and readmission rates after primary bariatric procedures.

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Correspondence to Marjolijn Leeman.

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Disclosures

Drs. Leeman, van Mil, Biter, Apers, prof. Verhoef and Dr. Dunkelgrun have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Dutch medical ethical committee (METC).

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Informed consent was obtained from all individual participants included in the study.

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Leeman, M., van Mil, S.R., Biter, L.U. et al. Reducing complication rates and hospital readmissions while revising the enhanced recovery after bariatric surgery (ERABS) protocol. Surg Endosc 35, 612–619 (2021). https://doi.org/10.1007/s00464-020-07422-w

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Keywords

  • Bariatric surgery
  • Fast-track
  • Enhanced recovery after surgery
  • ERABS
  • Gastric bypass
  • Gastric sleeve