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Enhanced Recovery after Surgery (ERAS): a Systematic Review of Randomised Controlled Trials (RCTs) in Bariatric Surgery

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Abstract

Objective

Our aim was to conduct an up-to-date systematic review of randomised controlled trials (RCTs) to determine the benefits and harms of enhanced recovery after surgery (ERAS) programme in bariatric surgery.

Methods

MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library were searched for RCTs on ERAS versus standard care (SC) until April 2020. The primary endpoint was the length of hospital stay (LOS).

Results

Five RCTs included a total of 610 procedures. ERAS adoption is capable of significantly reducing LOS (MD of − 0.51; 95% CI − 0.92 to − 0.10; P = 0.01) and postoperative nausea and vomiting (PONV) (OR 0.42; 95% CI 0.19 to 0.95; P = 0.04). No significant differences in terms of adverse events and readmissions.

Conclusions

The implementation of ERAS in bariatric surgery produces a significant reduction in LOS and PONV.

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References

  1. Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8(8):CD003641.

    Google Scholar 

  2. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28(12):3783–94.

    Article  Google Scholar 

  3. Cardoso L, Rodrigues D, Gomes L, et al. Short- and long-term mortality after bariatric surgery: a systematic review and meta-analysis. Diabetes Obes Metab. 2017;19(9):1223–32.

    Article  PubMed  Google Scholar 

  4. Longitudinal Assessment of Bariatric Surgery C, Flum DR, Belle SH, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.

    Article  Google Scholar 

  5. Aminian A, Brethauer SA, Kirwan JP, et al. How safe is metabolic/diabetes surgery? Diabetes Obes Metab. 2015;17(2):198–201.

    Article  CAS  PubMed  Google Scholar 

  6. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA surgery. 2017;152(3):292–8.

    Article  PubMed  Google Scholar 

  7. 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(9):2065–83.

    Article  CAS  PubMed  Google Scholar 

  8. Mannaerts GH, van Mil SR, Stepaniak PS, et al. Results of implementing an enhanced recovery after bariatric surgery (ERABS) protocol. Obes Surg. 2016;26(2):303–12.

    Article  PubMed  Google Scholar 

  9. Barreca M, Renzi C, Tankel J, et al. Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center. Surg Obes Relat Dis. 2016;12(1):119–26.

    Article  PubMed  Google Scholar 

  10. Meunier H, Le Roux Y, Fiant AL, et al. Does the implementation of enhanced recovery after surgery (ERAS) guidelines improve outcomes of bariatric surgery? A propensity score analysis in 464 patients. Obes Surg. 2019;29(9):2843–53.

    Article  PubMed  Google Scholar 

  11. Brethauer SA, Grieco A, Fraker T, et al. Employing enhanced recovery goals in bariatric surgery (ENERGY): a national quality improvement project using the metabolic and bariatric surgery accreditation and quality improvement program. Surg Obes Relat Dis. 2019;15(11):1977–89.

    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(2):489–501.

    Article  PubMed  Google Scholar 

  13. Malczak P, Pisarska M, Piotr M, et al. Enhanced recovery after bariatric surgery: systematic review and meta-analysis. Obes Surg. 2017;27(1):226–35.

    Article  PubMed  Google Scholar 

  14. Ahmed OS, Rogers AC, Bolger JC, et al. Meta-analysis of enhanced recovery protocols in bariatric surgery. J Gastrointest Surg. 2018;22(6):964–72.

    Article  PubMed  Google Scholar 

  15. Lemanu DP, Singh PP, Berridge K, et al. Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy. Br J Surg. 2013;100(4):482–9.

    Article  CAS  PubMed  Google Scholar 

  16. Pimenta GP, Capellan DA, de Aguilar-Nascimento JE. Sleeve gastrectomy with or without a multimodal perioperative care. A randomized pilot study. Obes Surg. 2015;25(9):1639–46.

    Article  PubMed  Google Scholar 

  17. Geubbels N, Evren I, Acherman YIZ, et al. Randomized clinical trial of an enhanced recovery after surgery programme versus conventional care in laparoscopic Roux-en-Y gastric bypass surgery. BJS open. 2019;3(3):274–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Ruiz-Tovar J, Garcia A, Ferrigni C, et al. Impact of implementation of an enhanced recovery after surgery (ERAS) program in laparoscopic Roux-en-Y gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis. 2019;15(2):228–35.

    Article  PubMed  Google Scholar 

  19. Prabhakaran S, Misra S, Magila M, Kumar SS, Kasthuri S, Palanivelu C, Raj PP. Randomized Controlled Trial Comparing the Outcomes of Enhanced Recovery After Surgery and Standard Recovery Pathways in Laparoscopic Sleeve Gastrectomy. Obes Surg. 2020;30(9):3273-3279

  20. Higgins JPT TJ, Chandler J, Cumpston M, et al. (editors). Cochrane handbook for systematic reviews of interventions version 60 (updated July 2019) Cochrane, 2019.Available from www.training.cochrane.org/handbook.

  21. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bhandari M, Fobi MAL, Buchwald JN, Bariatric metabolic surgery standardization working G. Standardization of bariatric metabolic procedures: world consensus meeting statement. Obes Surg 2019;29(Suppl 4):309–345.

  23. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  24. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  25. Balasubramanian SP, Wiener M, Alshameeri Z, et al. Standards of reporting of randomized controlled trials in general surgery: can we do better? Ann Surg. 2006;244(5):663–7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719–48.

    CAS  PubMed  Google Scholar 

  27. Greenland S, Robins JM. Estimation of a common effect parameter from sparse follow-up data. Biometrics. 1985;41(1):55–68.

    Article  CAS  PubMed  Google Scholar 

  28. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Friedman HP, Goldberg JD. Meta-analysis: an introduction and point of view. Hepatology. 1996;23(4):917–28.

    Article  CAS  PubMed  Google Scholar 

  31. Day RW, Fielder S, Calhoun J, et al. Incomplete reporting of enhanced recovery elements and its impact on achieving quality improvement. Br J Surg. 2015;102(13):1594–602.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Neville A, Lee L, Antonescu I, et al. Systematic review of outcomes used to evaluate enhanced recovery after surgery. Br J Surg. 2014;101(3):159–70.

    Article  CAS  PubMed  Google Scholar 

  33. 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(6):1531–41.

    Article  PubMed  Google Scholar 

  34. Zhuang CL, Ye XZ, Zhang XD, et al. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56(5):667–78.

    Article  PubMed  Google Scholar 

  35. Aman MW, Stem M, Schweitzer MA, et al. Early hospital readmission after bariatric surgery. Surg Endosc. 2016;30(6):2231–8.

    Article  PubMed  Google Scholar 

  36. Berger ER, Huffman KM, Fraker T, et al. Prevalence and risk factors for bariatric surgery readmissions: findings from 130,007 admissions in the metabolic and bariatric surgery accreditation and quality improvement program. Ann Surg. 2018;267(1):122–31.

    Article  PubMed  Google Scholar 

  37. Groene P, Eisenlohr J, Zeuzem C, Dudok S, Karcz K, Hofmann-Kiefer K. Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery. Wideochir Inne Tech Maloinwazyjne. 2019;14(1):90-95

  38. Suh S, Helm M, Kindel TL, Goldblatt MI, Gould JC, Higgins RM. The impact of nausea on post-operative outcomes in bariatric surgery patients. Surg Endosc. 2020;34(7):3085-3091

  39. Major P, Wysocki M, Torbicz G, et al. Risk factors for prolonged length of hospital stay and readmissions after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2018;28(2):323–32.

    Article  PubMed  Google Scholar 

  40. Gustafsson UO, Oppelstrup H, Thorell A, et al. Adherence to the ERAS protocol is associated with 5-year survival after colorectal cancer surgery: a retrospective cohort study. World J Surg. 2016;40(7):1741–7.

    Article  PubMed  Google Scholar 

  41. Malczak P, Wysocki M, Twardowska H, et al. Impact of adherence to the ERAS(R) protocol on short-term outcomes after bariatric surgery. Obes Surg. 2020;30(4):1498–505.

    Article  PubMed  Google Scholar 

  42. Rubino F, Shukla A, Pomp A, et al. Bariatric, metabolic, and diabetes surgery: what’s in a name? Ann Surg. 2014;259(1):117–22.

    Article  PubMed  Google Scholar 

  43. Myles PS, Weitkamp B, Jones K, et al. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000;84(1):11–5.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Emergency and Digestive Surgery, St. Mary’s Hospital, 05100, Terni, Italy

    Amilcare Parisi, Jacopo Desiderio & Stefano Trastulli

  2. Department of Surgical and Biomedical Sciences, University of Perugia, St. Mary’s Hospital, 05100, Terni, Italy

    Roberto Cirocchi

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  1. Amilcare Parisi
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  2. Jacopo Desiderio
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  3. Roberto Cirocchi
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  4. Stefano Trastulli
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Correspondence to Stefano Trastulli.

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Conflict of Interest

Dr. Amilcare Parisi discloses the following relationship: Research grant from Ethicon Endo-Surgery. Dr. Jacopo Desiderio, Prof. Roberto Cirocchi and Dr. Stefano Trastulli declare that they have no conflict of interest.

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Parisi, A., Desiderio, J., Cirocchi, R. et al. Enhanced Recovery after Surgery (ERAS): a Systematic Review of Randomised Controlled Trials (RCTs) in Bariatric Surgery. OBES SURG 30, 5071–5085 (2020). https://doi.org/10.1007/s11695-020-05000-6

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  • DOI: https://doi.org/10.1007/s11695-020-05000-6

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