Skip to main content

Advertisement

Log in

Enhanced Recovery in Bariatric Surgery: A Study of Short-Term Outcomes and Compliance

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Introduction

The implementation of Enhanced Recovery After Surgery (ERAS) guidelines has been widely studied among various surgical specialties. We aimed at comparing the perioperative outcomes and compliance with ERAS protocol in bariatric surgery at our center.

Methods

An observational review of a prospectively maintained database was performed. Patients who underwent primary bariatric surgery (gastric bypass or sleeve gastrectomy) between January 2011 and June 2018 were included. Patients were divided into pre- and post-ERAS groups. Data including basic demographic information, length of hospital stay, 30-day perioperative complications, and readmission rates were collected. Compliance with elements of ERAS was assessed using a combination of chart review and a prospectively implemented checklist. P < 0.05 was chosen to be statistically significant.

Results

A total of 435 patients were included: 239 patients in the pre-ERAS group and 196 patients in the post-ERAS group. There were no statistical differences in baseline demographics and major comorbidities between the 2 groups. The post-ERAS group had shorter length of hospital stay (2.23 vs 1.23, p < 0.001) and lower rates of 30-day postoperative morbidity (8.7 vs 4%, p = .04).

There was no significant difference between the 2 groups with respect to readmissions rates. There was no mortality in either group. Overall compliance rates with ERAS elements were 85%; compliance increased significantly with the implementation of a checklist (p < 0.001).

Conclusions

Implementation of ERAS program for bariatric surgery is safe and feasible. It reduces hospital stay and postoperative morbidity. Easy to implement strategies such as checklists should be encouraged in bariatric programs to aid in implementation and compliance with ERAS elements for perioperative care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63:2985–3023.

  2. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.

    Article  CAS  PubMed  Google Scholar 

  3. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Greco M, Capretti G, Beretta L, et al. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38:1531–41.

    Article  PubMed  Google Scholar 

  5. Jones NL, Edmonds L, Ghosh S, et al. A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia. 2013;68:179–89.

    Article  CAS  PubMed  Google Scholar 

  6. Stowers MD, Lemanu DP, Coleman B, et al. Review article: perioperative care in enhanced recovery for total hip and knee arthroplasty. J Orthop Surg. 2014;22:383–92.

    Article  Google Scholar 

  7. Melnyk M, Casey RG, Black P, et al. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;5:342–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. 2016;40:2065–83.

    Article  CAS  PubMed  Google Scholar 

  9. Brewis A, SturtzSreetharan C, Wutich A. Obesity stigma as a globalizing health challenge. Glob Health [Internet]. 2018 [cited 2018 May 30];14. Available from: https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-018-0337-x. Accessed 26 Jul 2018.

  10. Jackson TD, Zhang R, Glockler D, Pennington J, Reddigan JI, Rotstein OD, et al. Health inequity in access to bariatric surgery: a protocol for a systematic review. Syst Rev [Internet]. 2014 [cited 2018 May 30];3. Available from: http://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-3-15. Accessed 26 Jul 2018.

  11. Ahmed OS, Rogers AC, Bolger JC, et al. Meta-analysis of enhanced recovery protocols in bariatric surgery. J Gastrointest Surg. 2018;22:964–72.

    Article  PubMed  Google Scholar 

  12. Singh PM, Panwar R, Borle A, et al. Efficiency and safety effects of applying ERAS protocols to bariatric surgery: a systematic review with meta-analysis and trial sequential analysis of evidence. Obes Surg. 2017;27:489–501.

    Article  PubMed  Google Scholar 

  13. Małczak P, Pisarska M, Piotr M, et al. Enhanced recovery after bariatric surgery: systematic review and meta-analysis. Obes Surg. 2017;27:226–35.

    Article  PubMed  Google Scholar 

  14. Awad S, Carter S, Purkayastha S, et al. Enhanced recovery after bariatric surgery (ERABS): clinical outcomes from a tertiary referral bariatric Centre. Obes Surg. 2014;24:753–8.

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sheaffer WW, Day RW, Harold KL, et al. Decreasing length of stay in bariatric surgery: the power of suggestion. Am J Surg. 2018;215:452–5.

    Article  CAS  PubMed  Google Scholar 

  17. Hoerger TJ, Zhang P, Segel JE, et al. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33:1933–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jonsson A, Lin E, Patel L, et al. Barriers to enhanced recovery after surgery after laparoscopic sleeve gastrectomy. J Am Coll Surg. 2018;226:605–13.

    Article  PubMed  Google Scholar 

  19. Deneuvy A, Slim K, Sodji M, et al. Implementation of enhanced recovery programs for bariatric surgery. Results from the Francophone large-scale database. Surg Obes Relat Dis. 2018;14:99–105.

    Article  PubMed  Google Scholar 

  20. Gotlib Conn L, McKenzie M, Pearsall EA, McLeod RS. Successful implementation of an enhanced recovery after surgery programme for elective colorectal surgery: a process evaluation of champions’ experiences. Implement Sci [Internet]. 2015 [cited 2018 Aug 10];10. Available from: http://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0289-y. Accessed 29 Jul 2018.

  21. Estimate of bariatric surgery numbers, 2011–2017 [Internet]. Am. Soc. Metab. Bariatr. Surg. [cited 2018 Aug 10]. Available from: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed 29 Jul 2018.

  22. Petrick AT, Still CD, Wood CG, et al. Feasibility and impact of an evidence-based program for gastric bypass surgery. J Am Coll Surg. 2015;220:855–62.

    Article  PubMed  Google Scholar 

  23. Jakobsen GS, Småstuen MC, Sandbu R, et al. Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. JAMA. 2018;319:291–301.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ikramuddin S, Korner J, Lee W-J, et al. Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin A 1c , LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study. JAMA. 2018;319:266–78.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Reges O, Greenland P, Dicker D, et al. Association of bariatric surgery using laparoscopic banding, Roux-en-Y gastric bypass, or laparoscopic sleeve gastrectomy vs usual care obesity management with all-cause mortality. JAMA. 2018;319:279–90.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Polle SW, Wind J, Fuhring JW, et al. Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg. 2007;24:441–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Iman Ghaderi.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Animal and Human Rights

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.

Disclosure Information

None of the authors have any financial conflicts to disclose. The study is based on the analysis from a bariatric database mandated by University of Arizona Institutional Review Board (IRB approval number 10-0744-01). No funding was provided for the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gondal, A.B., Hsu, CH., Serrot, F. et al. Enhanced Recovery in Bariatric Surgery: A Study of Short-Term Outcomes and Compliance. OBES SURG 29, 492–498 (2019). https://doi.org/10.1007/s11695-018-3579-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3579-z

Keywords

Navigation