Evaluation of an Enhanced Recovery After Surgery (ERAS) program on post-operative length of stay following laparoscopic sleeve gastrectomy

Reid Fletcher, MD, MPH, Emily Ramirez, RN, Alfonso Torquati, MD, Philip Omotosho, MD. Rush University Medical Center

Introduction: The objective of this study was to evaluate the impact of an Enhanced Recovery After Surgery (ERAS) program on post-operative length of stay following laparoscopic sleeve gastrectomy. ERAS programs have been demonstrated to improve outcomes and decrease length of stay in multiple surgical disciplines however relatively little has been published regarding the impact of ERAS programs in bariatric surgery.

Methods: An ERAS program for all patients undergoing bariatric surgery was implemented in February 2017 at a single institution. We retrospectively reviewed all patients undergoing laparoscopic sleeve gastrectomy between February 2017 and August 2017. As a pre-ERAS historical control, we also reviewed all patients undergoing laparoscopic sleeve gastrectomy between January 2016 and December 2016. Baseline patient characteristics, additional concomitant operative procedures as well as 30-day readmission and complication rates were reviewed. Logistic regression analysis was used in univariate and multivariate models to identify factors that predicted early post-operative discharge. Data analysis was completed using Stata 12 SE software (StataCorp LP; College Station, TX).

Results: Eighty-five patients underwent laparoscopic sleeve gastrectomy after implementation of the ERAS program while 169 patients were included in the pre-ERAS control group. There were no statistically significant differences in the baseline characteristics between the two groups and there were no differences in the rate of concomitant procedures performed. There was a statistically significant decrease in post-operative length of stay following implementation of the ERAS program from 2.23 (95% CI 2.1, 2.37) days in the pre-ERAS group to 1.84 (95% CI 1.68, 1.99) days in the post-ERAS group (p = 0.0004). There was also a significant increase in patients discharged home on the first post-operative day from 15.4% to 31.8% (p = 0.002) after beginning the ERAS program. In multivariate logistic regression, the only variable significantly associated with discharge on the first post-operative day was inclusion in the ERAS program (OR 2.57, 95% CI 1.36, 4.84). There were no significant differences in the rates of complications between the pre- and post-ERAS groups. Additionally, there were no complications noted for patients discharged on the first post-operative day and only 1 patient required readmission.

Conclusion: This study demonstrates that ERAS programs can significantly reduce length of stay following laparoscopic sleeve gastrectomy without an increase in post-operative complications or readmissions.