Bariatric – Enhanced Recovery Pathway

Preoperative

Patient attends preoperative visit with surgeon (1-2 weeks prior to surgery) to discuss post-operative course and expectations
Patient attends a separate educational class reaffirming short and long term expectations and recognizing complications
Patient given binder with all encompassing information related to perioperative journey

Patient given post-op scripts and 2 years of follow up appointments

2 week liquid diet prior to surgery if BMI > 45
NPO > 2400

Operative

Fluid management and Urine output:

1. intraop fluids limited to 1L
2. Foley not placed vs placed, but removed POD1

Intraop nausea management:

1. Decadron 8 mg
2. scopolamine patch for sleeve gastrectomy

Intraop pain management:

1. local long acting anesthetic at all incision sites and preperitoneal
2. toradol 30 mg

VTE prophylaxis:

1. preop lovenox 40mg
2. SCD

Postoperative

Fluid management:

1. limited to 100cc/h
2. hep lock in AM if tolerating liquids
3. liquid diet started 2 hours after surgery

Nausea management:

1. Zofran
2. Phenergan

Pain management:

1. PCA (morphine or dilaudid) until POD1
2. Liquid narcotic POD1
3. Around the clock toradol

VTE prophylaxis:

1. SCD while in bed
2. Lovenox 40mg continued 14 days post op

Anticipated discharge for patients is POD1
80%+ patients are discharged POD1orPOD2

No routine use of drains

No contrast studies to rule out leak (selective use of contrast study to evaluate anatomy of sleeve gastrectomy, however, this does not delay onset of PO intake)