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Implementing novel modalities into an institutional enhanced recovery after bariatric surgery (ERABS) protocol

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Abstract

Introduction

Enhanced recovery after bariatric surgery pathways are associated with improved postoperative outcomes. This study aims to assess efficacy and safety of three novel protocol contributions (transversus abdominis plane blocks, ketamine and fosaprepitant), as well as their impact on length of stay (LOS) and on postoperative complications.

Methods

Effectiveness and safety were retrospectively investigated in patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) over a 6-year period in a single institution. Group 1 patients were not exposed to any of our suggested interventions, whereas Group 2 were exposed to all of three.

Results

Between January 2015 and August 2021, 1480 patients underwent primary SG (77.6%) or RYGB (22.4%); of those, 1132 (76.5%) and 348 (23.5%) were in Groups 1 and 2, respectively. Mean BMI and age were 45.87 versus 43.65 kg/m2 and 45.53 versus 44.99 years in groups 1 and 2, respectively. Suggested interventions were associated with lower operative times (84.79 ± 24.21 vs. 80.78 ± 32.8 min, p = 0.025). In Group 2, the mean LOS decreased in 0.18 day (1.79 ± 1.04 vs. 1.60 ± 0.90; p = 0.004). Overall complication rates were 8% and 8.6% for groups 1 and 2, respectively; readmission rates were 5.7% (64 pts) vs. 7.2% (25 pts), p > 0.05. Reoperations were less prevalent in Group 2 (1.5% vs. 1.1%; p = 0.79).

Conclusion

Focus on optimized pain management, allied to a superior PONV control, may be relevant contributors for a lower LOS without negative impacts in complications rates.

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Authors and Affiliations

  1. Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA

    David Motola, Romulo Lind, Lauren Geisel, Gary Aghazarian, Muhammad Ghanem, Andre F. Teixeira & Muhammad A. Jawad

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  1. David Motola
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Correspondence to Romulo Lind.

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Disclosure

Doctors David Motola, Romulo Lind, Lauren Geisel, Gary Aghazarian, Muhammad Ghanem, Andre F. Teixeira, and Muhammad A. Jawad have no commercial associations or financial ties that might be a conflict of interest.

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This study has been approved by the appropriate institutional research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Motola, D., Lind, R., Geisel, L. et al. Implementing novel modalities into an institutional enhanced recovery after bariatric surgery (ERABS) protocol. Surg Endosc 37, 5421–5429 (2023). https://doi.org/10.1007/s00464-023-10027-8

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