Pearl K Ma, MD1, Aaron Lloyd, MPH2, Morgan Mcgrath, MAS2, Alice Jackson, RN2, Keith Boone, MD1, Kelvin Higa, MD1. 1University of California-San Francisco Fresno, 2Fresno Heart and Surgical Hospital
Enhanced recovery after surgery (ERAS) protocols have been well described in lower gastrointestinal surgery literature to decrease postoperative physiologic stress, decrease pain with increased mobility, and reduction in length of stay (LOS). However, implementation of ERAS in bariatric surgery has inconsistent results, especially as protocols varies immensely from each program with a predominant focus on reduction of length of stay. Our focus in implementing enhance recovery after bariatric surgery (ERABS) protocols were aimed at decreasing postoperative pain and therefore reducing opioid use.
Methods: Retrospective review of patients who underwent laparoscopic primary bariatric surgeries of either Roux-en-Y gastric bypass or sleeve gastrectomy at single high volume center between June 2016 to October 2017.
3 groups were examined with “Control” group defined as without any protocol changes. “Exparel” group without protocol changes except intraoperative injection of liposomal bupivacaine (Exparel©). ERABS/Exparel group implemented ERABS protocol (Figure 1). Postoperative course, narcotic use, and 30-day outcome rates were analyzed using combination of t-test and Mann-Whitney U.
Results: 1314 patients were analyzed. Table 1 describes the addition of Exparel without ERABS. Narcotic requirements were measured as morphine equivalent units (MEU). Overall MEU was decreased, improved patient experience and better pain level scores. With the addition of ERABS, a significantly greater response was found even when compared to control/Pre-Exparel group and even Exparel alone group with a 60% reduction in narcotic use in the hospital, with more patients (10% versus 0% of patients in control group, p <0.05) not requiring any narcotics postoperatively.
Table 2. describes changes from in pain scores of 1-10, length of stay, and total narcotic requirements. Decreased readmission rates, reoperation rates within 30 day outcomes were also examined between groups in Table 3.
Conclusions: Implementation of ERABS significantly reduced postoperative narcotic use and improved pain scores with more effect found the addition of intraoperative use of Exparel©. Although there was no decrease in our already low rates of length of stay, 30 day readmission rate and reoperation rates were significantly reduced in primary bariatric surgeries with ERABS protocol.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93472
Program Number: S106
Presentation Session: Bariatric III – Optimizing Care and Pathways
Presentation Type: Podium