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27.02.2018 | Original Article | Ausgabe 6/2018

Journal of Gastrointestinal Surgery 6/2018

Meta-Analysis of Enhanced Recovery Protocols in Bariatric Surgery

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 6/2018
Autoren:
Ola S. Ahmed, Ailín C. Rogers, Jarlath C. Bolger, Achille Mastrosimone, William B. Robb

Abstract

Background

Enhanced recovery after surgery (ERAS) guidelines, fast-track protocols, and alternative clinical pathways have been widely promoted in a variety of disciplines leading to improved outcomes in post-operative morbidity and length of stay (LOS). This meta-analysis assesses the implications of standardized management protocols in bariatric surgery.

Methods

The PRISMA guidelines were adhered to. Databases were searched with the application of pre-defined inclusion and exclusion criteria. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Individual protocols and surgical approaches were assessed through subgroup analysis, and sensitivity analysis of methodological quality was performed.

Results

A total of 1536 studies were screened; 13 studies were eventually included for meta-analysis involving a total of 6172 patients. Standardized perioperative techniques were associated with a savings of 19.5 min in operative time (p < 0.01), as well as a LOS which was shortened by 1.5 days (p < 0.01). Pooled post-operative morbidity rates also favored enhanced recovery care protocols (OR 0.7%, 95% CI 0.6–0.9%, p < 0.01).

Conclusion

Bariatric surgery involves a complex cohort of patients who require high-quality evidence-based care to improve outcomes. Consensus guidelines on the feasibility of ERAS and alternative clinical pathways are required in the setting of bariatric surgery.

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