Jenny Lam, MD, Toshiaki Suzuki, MD, Carlos T Maeda, MD, David Bernstein, MD, Thach Pham, MD, Bryan J Sandler, MD, Garth R Jacobsen, MD, FACS, Santiago Horgan, MD. University Of California – San Diego
Objective: To establish if an Enhanced recovery after surgery (ERAS) protocol can be performed safely in bariatric surgery.
Background: Laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric surgeries in the world. Enhanced recovery after surgery (ERAS) protocols have been shown to reduce complications and decrease the length of stay for various types of surgeries. There has been a recent initiative to standardize ERAS guidelines, specifically for bariatric surgery, however a consensus has not been reached. In this study, we propose a ERAS protocol for laparoscopic sleeve gastrectomy and compare the clinical outcomes with patients who received standard care.
Methods: We performed a retrospective analysis of prospectively collected data in patients who underwent laparoscopic sleeve gastrectomy from December 2010 to July 2017, at a single institution. Patients were stratified into two groups, standard care and ERAS protocol groups. The ERAS protocol consists of a specific medication regimen pre- and post-op, early ambulation, early oral intake, and post-operative upper GI swallow study. Patients are discharged on their first post-operative day if they meet appropriate post-surgical milestones. Propensity score matching was used for age, gender, BMI and obesity related comorbidities. The primary outcome was length of hospital stay. Secondary outcomes included rate of readmission, complication rates, and mortality. Complication rates were based on Clavien-Dindo classification of II and above.
Results: We included 353 patients who underwent sleeve gastrectomy, of which 261 were in the standard care group, and 92 were in the ERAS group. After matching, 90 patients were extracted in each group.Median hospital stay was significantly shorter in the ERAS group (1 day) compared to the standard care group (2 days; p < 0.0001). There was no difference in 7 or 30 day readmission rates (2.2% vs 2.2%; p = 1.000, 2.2% vs 3.3%; p =0.650) or post-operative complications (2.2 vs 5.6%; p=0.247). Mortality rate was 0% overall.
Conclusion: ERAS protocol for laparoscopic sleeve gastrectomy results in shorter length of stay, without increase in perioperative morbidity or readmission rates.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87938
Program Number: S132
Presentation Session: ERAS Session
Presentation Type: Podium