Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Bariatric Surgery

Grant, Michael C.; Gibbons, Melinda M.; Ko, Clifford Y.; Wick, Elizabeth C.; Scott, Michael J.; McEvoy, Matthew D.; King, Adam; Wu, Christopher L.

doi:10.1213/ane.0000000000003696

Cited by 23 publications

(5 citation statements)

References 70 publications

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“… Based on information included in Grant et al Anesth Analg . 2019;129:51‐60 ; Thorell et al World J Surg . 2016;40:2065‐2083 ; Ljungqvist et al JAMA .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

321

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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“… Based on information included in Grant et al Anesth Analg . 2019;129:51‐60 ; Thorell et al World J Surg . 2016;40:2065‐2083 ; Ljungqvist et al JAMA .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

321

464

View full text Add to dashboard Cite

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“…Of note, some recommend that NSAIDs should be avoided after LSG due to the risk of ulcer development [32]. However, recently published enhanced recovery pathways recommend the use of NSAIDs [3,4]. Of note, the evidence suggesting development of marginal ulcers with the use of NSAIDs is predominately from Roux-en-Y procedures rather than LSG.…”

Section: Discussionmentioning

confidence: 99%

“…LSG is commonly performed on an outpatient or overnight stay basis [2]. However, there is a lack of a consensus on an optimal analgesic regimen [3,4].…”

Section: Introductionmentioning

confidence: 99%

Evidence‐Based Management of Postoperative Pain in Adults Undergoing Laparoscopic Sleeve Gastrectomy

et al. 2019

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Background Laparoscopic sleeve gastrectomy (LSG) is a common weight loss operation that is increasingly being managed on an outpatient or overnight stay basis. The aim of this systematic review was to evaluate the available literature and develop recommendations for optimal pain management after LSG. Methods A systematic review utilizing preferred reporting items for systematic reviews and meta‐analysis with PROcedure SPECific Postoperative Pain ManagemenT methodology was undertaken. Randomized controlled trials (RCTs) published in the English language from inception to September 2018 assessing postoperative pain using analgesic, anesthetic, and surgical interventions were identified from MEDLINE, EMBASE and Cochrane Databases. Results Significant heterogeneity was identified in the 18 RCTs included in this systematic review. Gabapentinoids and transversus abdominis plane blocks reduced LSG postoperative pain. There was limited procedure‐specific evidence of analgesic effects for acetaminophen, non‐steroidal anti‐inflammatory drugs, dexamethasone, magnesium, and tramadol in this setting. Inconsistent evidence was found in the studies investigating alpha‐2‐agonists. No evidence was found for intraperitoneal local anesthetic administration or single‐port laparoscopy. Conclusions The literature to recommend an optimal analgesic regimen for LSG is limited. The pragmatic view supports acetaminophen and a non‐steroidal anti‐inflammatory drug, with opioids as rescue analgesics. Gabapentinoids should be used with caution, as they may amplify opioid‐induced respiratory depression. Although transversus abdominis plane blocks reduced pain, port‐site infiltration may be considered instead, as it is a simple and inexpensive approach that provides adequate somatic blockade. Further RCTs are required to confirm the influence of the recommended analgesic regimen on postoperative pain relief.

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“…[1][2][3][4] Borrowing from the original colorectal version of the program, groups have now applied ERP principles to numerous additional service lines. [5][6][7] Success among these procedures has led providers to adapt ERP frameworks to cardiac surgery, for which limited early examples have shown that an ERP for cardiac surgery is equal parts feasible, advisable, and potentially effective, [8][9][10][11][12][13] with at least 1 recent study that reported reduced length of stay (LOS) and improved indices of patient satisfaction associated with their program. 14 ERPs have relied thus far on the theory of marginal gains, whereby results are based on the summation of incremental-and often statistically imperceptible-benefits.…”

Section: Perspectivementioning

confidence: 99%