title: Results of Implementing an Enhanced Recovery After Bariatric Surgery (ERABS) Protocol.
abstract: BACKGROUND
  With the increasing prevalence of morbid obesity and healthcare costs in general, interest is shown in safe, efficient, and cost-effective bariatric care. This study describes an Enhanced Recovery After Bariatric Surgery (ERABS) protocol and the results of implementing such protocol on procedural times, length of stay in hospital (LOS), and the number of complications, such as readmissions and reoperations.
  
  
  METHODS
  Results of implementing an ERABS protocol were analyzed by comparing a cohort treated according to the ERABS protocol (2012-2014) with a cohort treated before implementing ERABS (2010-2012). Differences between both cohorts were analyzed using independent t tests and chi-squared tests.
  
  
  RESULTS
  A total of 1.967 patients (mean age 43.3 years, 80% female) underwent a primary bariatric procedure between 2010 and 2014, of which 1.313 procedures were performed after implementation of ERABS. A significant decrease of procedural times and a significantly decreased LOS, from 3.2 to 2.0 nights (p < 0.001), were seen after implementation of ERABS. Significantly more complications were seen post-ERABS (16.1 vs. 20.7%, p = 0.013), although no significant differences were seen in the number of major complications.
  
  
  CONCLUSIONS
  Implementation of ERABS can result in shorter procedural times and a decreased LOS, which may lead to more efficient and cost-effective bariatric care. The increase in complications was possibly due to better registration of complications. The main goal of an ERABS protocol is efficient, safe, and evidence-based bariatric care, which can be achieved by standardization of the total process.
authors.affiliation: Department of Surgery, Sint Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands. GMannaerts@tawamhospital.ae.|Department of Surgery, Tawam Hospital, PO Box 15258, Al Ain, United Arab Emirates. GMannaerts@tawamhospital.ae.
authors.forename: Guido H H
authors.initials: GH
authors.lastname: Mannaerts
authors.affiliation: Department of Surgery, Sint Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands. s.vanmil@sfvg.nl.
authors.forename: Stefanie R
authors.initials: SR
authors.lastname: van Mil
authors.affiliation: Operation room management, Catharina Ziekenhuis, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands. pieter.stepaniak@gmail.com.
authors.forename: Pieter S
authors.initials: PS
authors.lastname: Stepaniak
authors.affiliation: Department of Surgery, Sint Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands. m.dunkelgrun@sfvg.nl.
authors.forename: Martin
authors.initials: M
authors.lastname: Dunkelgrün
authors.affiliation: Department of Anesthesiology, Sint Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands. m.quelerij@sfvg.nl.
authors.forename: Marcel
authors.initials: M
authors.lastname: de Quelerij
authors.affiliation: Department of Anesthesiology, Sint Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands. s.verbrugge@sfvg.nl.
authors.forename: Serge J
authors.initials: SJ
authors.lastname: Verbrugge
authors.affiliation: Department of Surgery, Sint Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands. h.zengerink@sfvg.nl.
authors.forename: Hans F
authors.initials: HF
authors.lastname: Zengerink
authors.affiliation: Department of Surgery, Sint Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands. u.biter@sfvg.nl.
authors.forename: L Ulas
authors.initials: LU
authors.lastname: Biter
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D002985:Clinical Protocols; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009767:Obesity, Morbid / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data
keywords: Bariatric surgery; ERABS protocol; Fast-track protocol; Morbid obesity; Roux-en-Y gastric bypass; Sleeve gastrectomy