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Implementation of updated enhanced recovery after bariatric surgery guidelines: adapted protocol in a single tertiary center

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Abstract

The aim of this study is to evaluate the effects of an adapted protocol of enhanced recovery after bariatric surgery (ERABS) on outcomes. This is a single-center observational study comparing patients managed according to adapted ERABS protocol (March–May 2022) with a control group of old method (January 2021–February 2022). Totally, 253 bariatric patients were included in the study (n = 68) and control (n = 185) groups. Patients were mostly females (57.3% vs 70.2%; p = 0.053), of mean age 38.8 years and body mass index 41 ± 6.53 vs. 44.60 ± 7.37 kg/m2 (p = 0.007) in study and control groups, respectively. The majority (90.5%) underwent primary bariatric surgery. Adapted ERABS protocol compliance was 98.5%. The study group had shorter hospital stay (mean 2.86 ± 0.51 vs. 4.03 ± 0.28 days; p < 0.001), similar rates of total (3% vs. 2.7%, p = 0.92) and major complications (1.5% vs. 0, p = 0.10). Readmission rates were similar (1.5% vs 1.6%, p = 0.92). Applied only in the study group, early ambulation (p < 0.001), opioid restriction, and preventing postoperative nausea and vomiting (PONV), resulted in satisfactory scores (mean total visual analogue score 1.93 ± 0.80, morphine milligram equivalent 34.0 ± 14.5, and mean total PONV grade 0.17 ± 0.36). In conclusion, implementing adapted ERABS guidelines improved patients’ postoperative care, raising awareness to pain management. Length of stay was shortened without safety compromise. Efforts to abandon old-school routines seem worthwhile, even if ERABS is partially implemented.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel

    Adam Abu-Abeid & Danit Dayan

  2. Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-via S. Pansini 5, 80131, Naples, Italy

    Adam Abu-Abeid, Antonio Vitiello, Giovanna Berardi, Nunzio Velotti, Vincenzo Schiavone, Antonio Franzese & Mario Musella

Authors
  1. Adam Abu-Abeid
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  2. Antonio Vitiello
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  3. Giovanna Berardi
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  4. Danit Dayan
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  6. Vincenzo Schiavone
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Correspondence to Adam Abu-Abeid.

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Abu-Abeid, A., Vitiello, A., Berardi, G. et al. Implementation of updated enhanced recovery after bariatric surgery guidelines: adapted protocol in a single tertiary center. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01824-4

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