One Hundred Seventy-Nine Consecutive Bariatric Operations after Introduction of Protocol Inspired by the Principles of Enhanced Recovery after Surgery (ERAS®) in Bariatric Surgery
Maciej Matłok, Michał Pędziwiatr, Piotr Major, Stanisław Kłęk, Piotr Budzyński, Piotr Małczak
(2nd Department of General Surgery, Jagiellonian University – Medical College, Cracow, Poland)
Med Sci Monit 2015; 21:791-797
Obese patients are a very large high-risk group for complications after surgical procedures. In this group, optimized perioperative care and a faster recovery to full activity can contribute to a decreased rate of postoperative complications. The introduction of ERAS®-based protocol is now even more important in bariatric surgery centers. The results of our study support the idea of implementation of ERAS®-based protocol in this special group of patients.
MATERIAL AND METHODS: This analysis included 170 patients (62 male/108 female, mean BMI 46.7 kg/m2) who had undergone laparoscopic bariatric surgery, and whose perioperative care was conducted according to a protocol inspired by ERAS® principles. Examined factors included oral nutrition tolerance, time until mobilization after surgery, requirements for opioids, duration of hospitalization, and readmission rate.
RESULTS: During the first 24 postoperative hours, oral administration of liquid nutrition was tolerated by 162 (95.3%) patients and 163 (95.8%) were fully mobile. In 44 (25.8%) patients it was necessary to administer opioids to relieve pain. Intravenous liquid supply was discontinued within 24 hours in 145 (85.3%) patients. The complication rate was 10.5% (mainly rhabdomyolysis and impaired passage of gastric contents). The average time of hospitalization was 2.9 days and the readmission rate was 1.7%.
CONCLUSIONS: The introduction of an ERAS® principles-inspired protocol in our center proved technically possible and safe for our patients, and allowed for reduced hospitalization times without increased rate of complications or readmissions.
Keywords: Adult, Adolescent, Aged, Bariatric Surgery - adverse effects, Demography, Female, Humans, Male, Middle Aged, Obesity - surgery, Patient Discharge, Postoperative Complications - etiology, Recovery of Function, young adult