Sara Monfared, MD, Marisa Embry, RN, Ambar Banerjee, MD, Dimitrios Stefanidis, PhD, MD. Indiana University
Introduction: Enhanced recovery programs have proven effective after various operations but their value after minimally invasive bariatric surgery is less clear and potentially harder to demonstrate given already speedy recovery. Employing New Enhanced Recovery Goals in Bariatric Surgery (ENERGY) is a new program of the American Society for Metabolic and Bariatric Surgery that aims to improve postoperative outcomes. Our objective was to assess the impact of ENERGY implementation on postoperative outcomes after bariatric surgery and identify strategies that have the highest opioid-sparing effect.
Methods: Prospectively collected data on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database were reviewed. Patient outcomes after laparoscopic roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) during the year before and the year after implementation of ENERGY (July 2017) were compared. Data analyzed included age, gender, procedure type, length of stay (LOS), 30-day complications, readmissions, and reoperations. Multilinear regression analysis was performed to control for age, gender and procedure type as possible confounders. Average morphine equivalent dosage used during their hospital stay was compared between those who received regional anesthetic block and those who did not.
Results: Outcomes from 531 patients were analyzed, 206 before and 325 after ENERGY implementation. Mean LOS decreased by 0.2 days after ENERGY (p=0.085). The percentage of patients with LOS ≥ 4 days also decreased from 9.2% to 6.5% (p=0.24). Postoperative complication, readmission and reoperation rates were similar between the two groups (table 1) even after controlling for age, gender and procedure type as possible confounders. Patients who received a local anesthetic regional block used an average of 30.5 mg of morphine less during their hospital stay compared with those who did not (p=0.052).
Conclusions: Promising downward trends in patient LOS, complication, readmission and reoperation rates were observed after the implementation of ENERGY in our bariatric program that warrant further study and analysis within a larger sample. Regional anesthesia limits opioid use after surgery and should be considered.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95708
Program Number: P070
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster