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Meta-Analysis of Enhanced Recovery Protocols in Bariatric Surgery

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Enhanced recovery after surgery (ERAS) guidelines, fast-track protocols, and alternative clinical pathways have been widely promoted in a variety of disciplines leading to improved outcomes in post-operative morbidity and length of stay (LOS). This meta-analysis assesses the implications of standardized management protocols in bariatric surgery.

Methods

The PRISMA guidelines were adhered to. Databases were searched with the application of pre-defined inclusion and exclusion criteria. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Individual protocols and surgical approaches were assessed through subgroup analysis, and sensitivity analysis of methodological quality was performed.

Results

A total of 1536 studies were screened; 13 studies were eventually included for meta-analysis involving a total of 6172 patients. Standardized perioperative techniques were associated with a savings of 19.5 min in operative time (p < 0.01), as well as a LOS which was shortened by 1.5 days (p < 0.01). Pooled post-operative morbidity rates also favored enhanced recovery care protocols (OR 0.7%, 95% CI 0.6–0.9%, p < 0.01).

Conclusion

Bariatric surgery involves a complex cohort of patients who require high-quality evidence-based care to improve outcomes. Consensus guidelines on the feasibility of ERAS and alternative clinical pathways are required in the setting of bariatric surgery.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Esophagogastric and General Surgery, Beaumont Hospital, Dublin 9, Ireland

    Ola S. Ahmed, Ailín C. Rogers, Jarlath C. Bolger, Achille Mastrosimone & William B. Robb

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  1. Ola S. Ahmed
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  2. Ailín C. Rogers
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  3. Jarlath C. Bolger
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Contributions

OSA acquired and analyzed the data and drafted the manuscript.

ACR acquired and analyzed the data and revised the manuscript.

JB and AM revised the manuscript.

WBR conceived and designed the study, revised, and gave final approval to the manuscript.

Corresponding author

Correspondence to William B. Robb.

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The authors declare that they have no conflict of interest.

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Ahmed, O.S., Rogers, A.C., Bolger, J.C. et al. Meta-Analysis of Enhanced Recovery Protocols in Bariatric Surgery. J Gastrointest Surg 22, 964–972 (2018). https://doi.org/10.1007/s11605-018-3709-x

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  • DOI: https://doi.org/10.1007/s11605-018-3709-x

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