Does the Implementation of Enhanced Recovery After Surgery (ERAS) Guidelines Improve Outcomes of Bariatric Surgery? A Propensity Score Analysis in 464 Patients

Meunier, Hugo; Roux, Yannick Le; Fiant, Antony; Marion, Yoann; Bion, Adrien Lee; Gautier, Thomas; Contival, Nicolas; Lubrano, Jean; Fobe, F.; Zamparini, Marion; Piquet, Marie-Astrid; Savey, Véronique; Alvès, Arnaud; Menahem, Benjamin

doi:10.1007/s11695-019-03943-z

Cited by 29 publications

(20 citation statements)

References 42 publications

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“…A retrospective study of a gastric bypass population reported no difference in anastomotic dehiscence and reintervention rates in patients receiving abdominal drainage compared to those who are not [ 167 ]. Avoiding abdominal drainage was found to be a key item in the ERABS [ 3 , 11 , 12 , 14 , 17 , 19 , 59 , 67 , 168 ]. Society positions in favor of abandoning the routine use of abdominal drainage, when possible, are available [ 3 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

“…Independent mobilization for at least 4 h during the first 24 h following surgery was significantly associated with a lower rate of postoperative complications and a shorter LOS [ 173 ]. Early postoperative mobilization was reported as a key element of better postoperative recovery in ERABS [ 17 – 20 , 29 , 39 , 54 – 59 , 67 , 168 , 172 ], and adequate independent mobilization was a condition for a home discharge [ 14 , 18 , 21 , 39 , 54 , 56 , 58 , 59 , 67 ].…”

Section: Resultsmentioning

confidence: 99%

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Enhanced recovery after bariatric surgery: an Italian consensus statement

Marinari

Foletto²,

Nagliati

et al. 2022

Surg Endosc

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Background Enhanced recovery after bariatric surgery (ERABS) is an approach developed to improve outcomes in obese surgical patients. Unfortunately, it is not evenly implemented in Italy. The Italian Society for the Surgery of Obesity and Metabolic Diseases and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care joined in drafting an official statement on ERABS. Methods To assess the effectiveness and safety of ERABS and to develop evidence-based recommendations with regard to pre-, intra-, and post-operative care for obese patients undergoing ERABS, a 13-member expert task force of surgeons and anesthesiologists from Italian certified IFSO center of excellence in bariatric surgery was established and a review of English-language papers conducted. Oxford 2011 Levels of Evidence and U.S. Preventive Services Task Force Grade Definitions were used to grade the level of evidence and the strength of recommendations, respectively. The supporting evidence and recommendations were reviewed and discussed by the entire group at meetings to achieve a final consensus. Results Compared to the conventional approach, ERABS reduces the length of hospital stay and does not heighten the risk of major post-operative complications, re-operations, and hospital re-admissions, nor does it increase the overall surgical costs. A total of 25 recommendations were proposed, covering pre-operative evaluation and care (7 items), intra-operative management (1 item, 11 sub-items), and post-operative care and discharge (6 items). Conclusions ERABS is an effective and safe approach. The recommendations allow the proper management of obese patients undergoing ERABS for a better outcome.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Enhanced recovery after bariatric surgery: an Italian consensus statement

Marinari

Foletto²,

Nagliati

et al. 2022

Surg Endosc

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“…All indications for primary and revisional bariatric surgeries were approved in an interdisciplinary consensus meeting. All surgical procedures were standardized in our center and were previously described in the literature [ 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center

Auge

Dejardin

Menahem

et al. 2022

JCM

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Few studies have evaluated the association between non-clinical and clinical determinants in terms of discontinuing follow-up after bariatric surgery. This cohort study aims to assess these associations. Data were collected from a prospectively maintained database of patients who underwent laparoscopic bariatric surgery from January 2012 to December 2019. The Cox model was used to assess the influence of preoperative determinants on follow-up interruptions for more than one year. Multilevel logistic regression was used to evaluate the association between clinical factors and post-operative weight loss with the regularity of follow-up. During the study period, 9607 consultations were performed on 1549 patients. The factors associated with a follow-up interruption from more than 365 days included male gender (HR = 1.323; CI = 1.146–1.527; p = 0.001) and more recent years of intervention (HR = 1.043; CI = 1.012–1.076; p = 0.0068). Revisional bariatric surgery was associated with a lower risk of follow-up interruption (HR = 0.753; CI = 0.619–0.916; p = 0.0045). Independent risk factors of an irregular follow up were higher age (HR = 1.01; CI = 1.002–1.017; p = 0.0086); male gender (OR = 1.272; CI = 1.047–1.545; p = 0.0153); and higher %TWL (Total Weight Loss) (OR = 1.040 CI = 1.033–1.048 p < 0.0001). A higher preoperative BMI (OR = 0.985; CI = 0.972–0.998; p = 0.0263) and revisional surgery (OR = 0.707; CI = 0.543–0.922; p = 0.0106) were protective factors of irregularity. This study suggests that the male gender and most recent dates of surgery are the two independent risk factors for follow-up interruption. Older age, male gender, and higher weight loss were all independent risk factors of an irregular follow-up. Revision bariatric surgery is a protective factor against interruption and irregular follow-up with a higher preoperative BMI. Further studies are needed to obtain long-term results in these patients with discontinued follow-ups.

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“…Previously, advanced age was considered a relative contraindication for bariatric surgery [3]. However, the evolution of laparoscopic techniques and advances in perioperative care protocols have changed perceptions [4,5].…”

Section: Introductionmentioning

confidence: 99%

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

et al. 2022

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Background Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort. Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups — patients ≥ 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality. Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 ± 2.5 years, 119.5 ± 24.5 kg, and 43 ± 7 in Group I and 39.8 ± 11.3 years, 117.7±20.4 kg, and 43.7 ± 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I (11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups. Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those ≥ 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups. Graphical abstract

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Does the Implementation of Enhanced Recovery After Surgery (ERAS) Guidelines Improve Outcomes of Bariatric Surgery? A Propensity Score Analysis in 464 Patients

Cited by 29 publications

References 42 publications

Enhanced recovery after bariatric surgery: an Italian consensus statement

Enhanced recovery after bariatric surgery: an Italian consensus statement

Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

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