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Enhanced Recovery after Bariatric Surgery: 202 Consecutive Patients in an Italian Bariatric Center

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Abstract

Background

Enhanced Recovery After Surgery (ERAS) pathways have been shown to improve postoperative outcomes. However, its application in bariatric surgery is still limited. The aim of the study was to define the safety of ERAS in bariatric patients with regard to postoperative complications, length of hospital stay (LOS), and readmission rates within 30 days from surgery.

Methods

The effectiveness and safety of an ERAS protocol was prospectively investigated in morbidly obese patients who underwent bariatric surgery in a single-institute experience over a 2-year period.

Results

Between June 2016 and September 2018, a total of 89 laparoscopic sleeve gastrectomy (SG), 105 Roux-en-Y gastric bypass (RYGB), and 8 one-anastomosis gastric bypass (OAGB) were performed. Twenty patients (9.9%) were revisional cases. Mean (standard deviation, SD) BMI and age at time of surgery were 43.2 (± 6.2) kg/m2 and 46 (± 11.3) years, respectively. Median (range) surgical time was 118 (45–255) minutes. Overall postoperative complication rate was 7.4%, with 6 (3.0%) patients developing grade III–IV complications according to the Clavien-Dindo classification. Median (range) LOS was 2 (1–50) days, with mean (SD) LOS of 2.3 (± 3.6) days. Overall, 36.6% of patients were discharged by first postoperative day and 77.7% by second postoperative day. Readmission rate was 4.5%. No mortality was observed during the study period.

Conclusions

According to the results of the present study, ERAS in primary and revisional bariatric surgery is safe and feasible, with short LOS, low morbidity and readmission rates, and no mortality. A significant reduction of mean LOS was progressively noted over the study period.

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Author notes

  1. Carlo Nagliati and Marina Troian contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, San Giovanni di Dio Hospital, Via Fatebenefratelli 34, 34170, Gorizia, Italy

    Carlo Nagliati, Damiano Pennisi & Alessandro Balani

  2. Department of Surgery, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy

    Marina Troian

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  1. Carlo Nagliati
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  2. Marina Troian
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  3. Damiano Pennisi
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  4. Alessandro Balani
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Contributions

CN: substantial contributions to the conception and design of the work, revising it critically for important intellectual content, final approval of the version to be published. He agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved. MT: substantial contributions to the conception and design of the work; acquisition, analysis, and interpretation of data for the work; drafting the work; and final approval of the version to be published. She agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved. DP: substantial contributions to the acquisition of data for the work, revising it critically for important intellectual content and final approval of the version to be published. He agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved. AB: substantial contributions to the interpretation of data for the work, revising it critically for important intellectual content, final approval of the version to be published. He agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

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Correspondence to Carlo Nagliati.

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The authors declare that they have no conflict of interest.

Ethical Statement

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 Helsinki declaration and its later amendments or comparable ethical standards.

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

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Nagliati, C., Troian, M., Pennisi, D. et al. Enhanced Recovery after Bariatric Surgery: 202 Consecutive Patients in an Italian Bariatric Center. OBES SURG 29, 3133–3141 (2019). https://doi.org/10.1007/s11695-019-03962-w

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  • DOI: https://doi.org/10.1007/s11695-019-03962-w

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