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Reduction of opioid use after implementation of enhanced recovery after bariatric surgery (ERABS)

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Enhanced recovery after surgery (ERAS) protocols have been extensively proven in lower gastrointestinal surgery to decrease postoperative physiologic stress and length of stay (LOS). ERAS in bariatric surgery (ERABS) varies immensely from each program with inconsistent results with a predominant goal of reducing LOS. Our focus in implementing enhanced recovery after bariatric surgery (ERABS) protocols is aimed at reducing postoperative pain and opioid use.

Methods

This is a retrospective review of patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (VSG) at a single high-volume center from June 2016 to October 2017. Patients on previous standard protocol were categorized into “Pre-Liposomal Bupivacaine (LB) group.” After routine use of Exparel™, patients were grouped into “LB group.” After ERABS protocol was initiated, patients were categorized into “ERABS/LB group.” Postoperative opioids were converted to morphine equivalents units (MEU); pain scores, LOS, and 30-day outcomes were analyzed using combination of t test and Mann–Whitney U.

Results

A total of 1340 patients were included in the study: 304 patients in pre-LB group; 754 patients in LB group, and 282 patients in ERABS/LB group. Total hospital opioid use was 58.6 MEU in pre-LB, 40.8 MEU in LB, and 23.8 MEU in ERABS/LB (p = 0.01). ERABS/LB group found a 59.5% decline in MEU requirements compared to pre-LB (p < 0.001) and 44.9% of patients did not require any additional narcotics on the floor compared to 0% in pre-LB group (p < 0.001). ERABS/LB LOS was an average of 1.48 days compared to 1.54 days in pre-LB group (p = 0.03) with an overall decrease of 3.74% in readmission rates (p = 0.03).

Conclusions

Implementation of ERABS significantly reduced postoperative opioid use, LOS, and readmissions. With ERABS, a more profound effect was observed than simply adding Exparel™ to preexisting protocols. Almost half of these patients did not require narcotics while recovering on the surgical floor. More studies are required to assess the true effect of ERABS without use of Exparel™.

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Acknowledgements

The authors would like to thank Fresno Heart and Surgical administration, anesthesia, nursing, pharmacy, and ancillary staff.

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Authors and Affiliations

  1. Advanced Laparoscopic Surgery Associates, University of California San Francisco-Fresno, 205 E. River Park Circle #460, Fresno, CA, 93720, USA

    Pearl Ma, Keith Boone & Kelvin Higa

  2. Fresno Heart and Surgical Hospital, Fresno, CA, USA

    Aaron Lloyd, Morgan McGrath, Riley Moore & Alice Jackson

Authors
  1. Pearl Ma
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  2. Aaron Lloyd
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  3. Morgan McGrath
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  4. Riley Moore
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  5. Alice Jackson
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  6. Keith Boone
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  7. Kelvin Higa
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Correspondence to Pearl Ma.

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Disclosures

Dr. Ma, Dr. Boone, Dr. Higa, Ms. A. Jackson, Ms. M. McGrath, Mr. R. Moore, and Mr. A. Lloyd have no conflicts of interest or financial ties to disclose, or association with any pharmaceutical companies.

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Ma, P., Lloyd, A., McGrath, M. et al. Reduction of opioid use after implementation of enhanced recovery after bariatric surgery (ERABS). Surg Endosc 34, 2184–2190 (2020). https://doi.org/10.1007/s00464-019-07006-3

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  • DOI: https://doi.org/10.1007/s00464-019-07006-3

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