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An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative day 1?

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic sleeve gastrectomy is the most commonly performed bariatric surgery in the world. Enhanced recovery after surgery (ERAS) protocols have been shown to reduce complications and decrease length of stay for various types of surgeries. In this study, we propose an ERAS protocol for laparoscopic sleeve gastrectomy and compare the clinical outcomes with patients who received standard care.

Methods

We performed a single-institution retrospective analysis in patients who underwent laparoscopic sleeve gastrectomy from February 2015 to December 2017. Patients were stratified into standard care and ERAS protocol groups. The ERAS protocol consisted of goal-directed patient education, specific pre- and post-op multi-modal medication regimen, early ambulation, and early oral intake. Patients were discharged on their first post-operative day if they met appropriate post-surgical milestones. The primary outcomes were length of stay, 7- and 30-day readmission rates, and complication rates. Secondary outcomes included anti-emetic and pain medication utilization, post-operative emesis episodes per day, post-operative pain scores, and mortality.

Results

We included 214 consecutive patients who underwent sleeve gastrectomy, 130 were in the ERAS group and 84 were in the standard care group. Median hospital stay was significantly shorter in the ERAS group compared to the standard care group (1 vs. 2 days; p < 0.001). There were no differences in 7- or 30-day readmission rates (1.5 vs. 1.2%; p = 0.838, 2.3 vs. 2.4%; p = 0.966) or post-operative complications (6.2 vs. 3.6%; p = 0.410). The ERAS group also had decreased median intra-operative opioid consumption and self-reported pain scores on post-operative day 1 (27.5 MME vs. 27.4 MME; p = 0.044, 3.3 vs. 3.9; p = 0.046). Mortality rate was 0% overall.

Conclusion

A cost-effective ERAS protocol for laparoscopic sleeve gastrectomy results in shorter length of stay, without increase in peri-operative morbidity or readmission rates.

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Authors and Affiliations

  1. Division of Minimally Invasive Surgery, University of San Diego, California, San Diego, CA, USA

    Jenny Lam, Toshiaki Suzuki, David Bernstein, Beiqun Zhao, Carlos Maeda, Thach Pham, Bryan J. Sandler, Garth R. Jacobsen, Joslin N. Cheverie & Santiago Horgan

  2. Center for the Future of Surgery, University of California at San Diego, MET Building, Lower Level, 9500 Gilman Drive MC 0740, La Jolla, CA, 92093-0740, USA

    Jenny Lam, Toshiaki Suzuki, David Bernstein, Beiqun Zhao, Carlos Maeda, Thach Pham, Bryan J. Sandler, Garth R. Jacobsen, Joslin N. Cheverie & Santiago Horgan

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  1. Jenny Lam
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Correspondence to Jenny Lam.

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Disclosures

Bryan J. Sandler reports Consulting Fee for ValenTx, Inc, and Honoraria for Gore and Bard-Davol; Garth R. Jacobsen reports Honoraria for Gore, Bard-Davol, and Ethicon. Santiago Horgan reports Consulting Fee for Fortimedix, Stryker and ValenTx, Inc. and Speaker for Ethicon. Authors Jenny Lam, Toshiaki Suzuki, Carlos Maeda, Beiqun Zhao, David Bernstein, and Thach Pham have no conflicts of interest or financial ties to disclose.

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Lam, J., Suzuki, T., Bernstein, D. et al. An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative day 1?. Surg Endosc 33, 580–586 (2019). https://doi.org/10.1007/s00464-018-6368-9

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  • DOI: https://doi.org/10.1007/s00464-018-6368-9

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