Original article
Enhanced recovery after surgery (ERAS) in one-anastomosis gastric bypass surgery: a matched-cohort study

https://doi.org/10.1016/j.soard.2018.08.029Get rights and content

Highlights

  • This matched-cohort study was designed to evaluate the effectiveness and safety of the enhanced recovery after surgery (ERAS) protocol in one anastomosis gastric bypass (OAGB) compared to the traditional approach.

  • The comparison of the groups was shown that ERAS pathway significantly reduced LOS and cost after OAGB, with no significant differences in terms of surgical outcomes.

  • It also reduces post-discharge resource utilization.

Abstract

Background

One-anastomosis gastric bypass (OAGB) is considered new from the bariatric standpoint.

Objectives

To assess the effectiveness and safety of the enhanced recovery after surgery protocol compared with the conventional approach in perioperative care of OAGB patients.

Setting

Turkey.

Methods

The prospectively collected data of 92 patients managed with standard care (group 1) were compared with 216 patients managed by the enhanced recovery after surgery pathway (group 2). All patients underwent OAGB by the same surgeon. The groups were compared in terms of mean postoperative length of stay; costs for surgery and recovery; and rates of complications, emergency room visits, and readmissions.

Results

Length of stay was always 5 days in group 1 and had a mean of 1.2 ± 1.3 days in group 2 (P < .001). The mean total cost for surgery and recovery was 858.6 ± 33.1 USD in group 1 and 625.2 ± 289.1 USD in group 2 (P < .001). Specific complications (Clavien-Dindo IIIa) occurred in 1 patient (1.1%) in group 1 and in 3 patients (1.4 %) in group 2 (P = 1.000). Fifty-seven patients (61.9%) in group 1 and 45 (20.9%) in group 2 visited the emergency room within 1 month of being discharged (P < .001). Two patients (.9%) in group 2 needed hospital readmission; there was no need for rehospitalization in group 1 (P < .001).

Conclusion

The enhanced recovery after surgery pathway significantly reduces length of stay and cost after OAGB, with no significant difference in terms of surgical outcomes. It also reduces postdischarge resource utilization.

Section snippets

Methods

Between October 2014 and April 2017, data were prospectively collected on all consecutive morbidly obese patients undergoing OAGB by a single surgeon who had a single co-worker anesthesiologist. The team used a conventional approach to perioperative care between October 2014 and March 2015. They then changed the approach to the ERAS pathway. The ERAS pathway was adapted from the works of Awad et al. [5] and Lemanu et al. [9]. The characteristics of the conventional approach and the ERAS pathway

Results

The characteristics of the patients in both groups are described in Table 2. Both groups were homogeneous for age, body mass index, co-morbidities, OT, complications, and mortality. The only difference between the groups was the sex ratio. The planned discharge on POD4 was achieved for all patients in group 1. All were admitted on the day before surgery, resulting in a total mean LOS of 5 days. In group 2, the planned discharge on POD1 was achieved for 188 patients (87%). One of the remaining

Discussion

The results from 2 cohorts, similar except for sex ratio, show that ERAS is a feasible and safe option for patients who undergo OAGB. Eighty-seven percent of the patients on ERAS met the goal of discharge on POD1. The simple changes, such as moving the hospital admission to the day of the operation, changing the target day of discharge to POD1, changing the anesthesia and analgesic protocols to short-acting agents and nonopioid painkillers, starting oral feeding early, and introducing nurse-led

Conclusion

The ERAS pathway significantly reduces the LOS of morbidly obese patients undergoing OAGB and reduces the number of 30-D ER visits. It also reduces the expenditure in 30-D follow-up without worsening surgical outcomes. Controlled randomized trials are needed to confirm these promising results.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (28)

  • MC Blanchet et al.

    Experience with an enhanced recovery after surgery (ERAS) program for bariatric surgery: comparison of MGB and LSG in 374 patients

    Obes Surg

    (2017)
  • DP Lemanu et al.

    Optimizing perioperative care in bariatric surgery patients

    Obes Surg

    (2012)
  • K Dogan et al.

    Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care

    Obes Surg

    (2015)
  • PA Clavien et al.

    The Clavien-Dindo classification of surgical complications: five-year experience

    Ann Surg

    (2009)
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