title: Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  Optimized perioperative care within an enhanced recovery after surgery (ERAS) protocol is designed to reduce morbidity after surgery, resulting in a shorter hospital stay. The present study evaluated this approach in the context of sleeve gastrectomy for patients with morbid obesity.
  
  
  METHODS
  Patients were allocated to perioperative care according to a bariatric ERAS protocol or a control group that received standard care. These groups were also compared with a historical group of patients who underwent laparoscopic sleeve gastrectomy at the same institution between 2006 and 2010, selected using matched propensity scores. The primary outcome was median length of hospital stay. Secondary outcomes included readmission rates, postoperative morbidity, postoperative fatigue and mean cost per patient.
  
  
  RESULTS
  Of 116 patients included in the analysis, 78 were allocated to the ERAS (40) or control (38) group and there were 38 in the historical group. There were no differences in baseline characteristics between groups. Median hospital stay was significantly shorter in the ERAS group (1 day) than in the control (2 days; P < 0·001) and historical (3 days; P < 0·001) groups. It was also shorter in the control group than in the historical group (P = 0·010). There was no difference in readmission rates, postoperative complications or postoperative fatigue. The mean cost per patient was significantly higher in the historical group than in the ERAS (P = 0·010) and control (P = 0·018) groups.
  
  
  CONCLUSIONS
  The ERAS protocol in the setting of bariatric surgery shortened hospital stay and was cost-effective. There was no increase in perioperative morbidity.
  
  
  BACKGROUND
  NCT01303809 (http://www.clinicaltrials.gov).
authors: Department of Surgery, South Auckland Clinical School, Auckland, New Zealand. daniel_lemanu@hotmail.com
authors: D P
authors: DP
authors: Lemanu
authors: P P
authors: PP
authors: Singh
authors: K
authors: K
authors: Berridge
authors: M
authors: M
authors: Burr
authors: C
authors: C
authors: Birch
authors: R
authors: R
authors: Babor
authors: A D
authors: AD
authors: MacCormick
authors: B
authors: B
authors: Arroll
authors: A G
authors: AG
authors: Hill
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000191:economics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009767:Obesity, Morbid / Q000191:economics / Q000601:surgery*; D019990:Perioperative Care / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D020127:Recovery of Function; D016896:Treatment Outcome