ERAS protocols in bariatric surgery: a systematic review

Dutton, Jaime; Wadhwa, Anupama; Morton, John M.

doi:10.1097/aia.0000000000000286

Cited by 5 publications

(1 citation statement)

References 26 publications

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“…The rst formal ERAS guideline for bariatric surgery was published in 2016 based on limited high-quality evidence speci c to bariatric surgery, and many of its recommendations are inferred from colorectal data (9). Newer systematic reviews with a greater proportion of randomized controlled trials support the safety and decreased length of stay (LOS) of ERAS protocols in bariatric surgery (10)(11). Multiple national consensus guidelines, which standardize implementation of ERAS nationally, support the recommendations originally made by Thorell et al (9,(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery After Surgery Facilitates Next Day Discharge for Laparoscopic Roux-en-Y Gastric Bypass: Experience from a Provincial Referral Program

Hardy¹,

Leung²,

Seto³

et al. 2023

Preprint

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Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common bariatric procedure, but patients often experience extended inpatient stays. Enhanced recovery after surgery (ERAS) protocols aim to expedite recovery and discharge. In the province of Manitoba, Canada, the Centre for Metabolic and Bariatric Surgery (CMBS) is dedicated to providing bariatric care to the population. To enable earlier discharge, an overnight short-stay unit with ERAS protocols was introduced, along with transfer protocols for patients requiring prolonged care. Methods We retrospectively reviewed prospectively collected data on LRYGBs performed from November 2017 to December 2020. Surgical indications included BMI ≥ 35 with comorbidities or BMI 40–55 without comorbidities, approved by a multidisciplinary bariatric team. Postoperative evaluations were conducted 16–21 hours post-surgery. Patients were educated about potential complications and required to reside within one hour of a tertiary center for seven days. This study reports descriptive outcomes: length of stay (LOS), 30-day emergency room (ER) presentations, 7-day readmissions, and 30-day readmissions. Results Among the 439 LRYGB patients, the postoperative day 1 discharge rate was 94.8%, and day 2 discharge rate was 1.8%. A small proportion (2.7%, n = 12) required transfer due to anticipated prolonged LOS, primarily for delayed intraabdominal hemorrhage (66.7%) requiring reoperation and precautionary measures for technically challenging procedures (16.7%). Two brief ICU admissions occurred, with no mortalities. ER presentation rate within 30 days was 10.3% (n = 45), 7-day readmission rate was 2.7% (n = 12), and 30-day readmission rate was 4.1% (n = 18). Gastrointestinal intolerance was the most common reason for readmission. Conclusion Implementing an ERAS protocol for LRYGB enabled safe next-day discharge for 94.8% of patients. ER presentation and readmission rates aligned with existing literature, supporting the feasibility of next-day discharge for appropriately selected bariatric patients. These findings contribute to the evidence base for optimizing postoperative care and enhancing patient outcomes in bariatric surgery.

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