An Enhanced Recovery After Surgery (ERAS) Protocol for Outpatient BodyLift Surgery

Abstract

The concept of enhanced recovery after surgery (ERAS) was developed in 2001 in order to create a multimodal, scientifically based approach to the development and audit of protocols for improving outcomes after surgical procedures. These protocols undergo constant evolution and evaluation toward the goal of quality of recovery. The BodyLift (BL) is the procedure that most comprehensively addresses the cosmetic needs of patients after massive weight loss (MWL). In the course of performing 136 consecutive outpatient BL surgeries over 7 years, we have developed a management protocol that has provided consistently high patient satisfaction, minimized frequent complications, and has documented 100% safety in all cases performed without deep vein thrombosis (DVT), transfusion and with 1 postoperative hospital admission. Each evidence-based component in the protocol was instituted to reduce risk of complications known to be most commonly associated with circumferential body contouring surgery. ERAS protocols are now widely used in many other surgical subspecialties. These protocols have the common goal of returning the patient to normal function as expeditiously as possible and are associated with decreased complications as well as shorter length-of-stay (LOS) and reduced costs. We have enumerated the many components of our protocol and aligned each with elements of an ERAS paradigm. In our retrospective review of 7 years of BL surgery (n = 136), this protocol has reduced both major and minor complications to previously unpublished levels. Our independently formulated ERAS protocol for outpatient BL surgery aligns closely with the ERAS concept, limiting surgical stress, thus reducing complications and affording a smooth and predictable perioperative experience. This is of importance for elective cosmetic surgery patients, who often have high expectations for an uneventful recovery and are unaccepting of potentially out-of-pocket costs associated with complications.