title: Outcome of Laparoscopic Gastric Bypass (LRYGB) with a Program for Enhanced Recovery After Surgery (ERAS).
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) programs are well established for patients undergoing colorectal surgery. Relatively little is known about ERAS following bariatric surgery in general or following laparoscopic Roux-en-Y gastric bypass (LRYGB) in particular.
  
  
  METHODS
  This is a prospective, observational study of 388 consecutive patients that underwent LRYGB with ERAS in a general hospital. The ERAS protocol included standardizations of pre-, intra-, and postoperative modalities in order to reduce the stress response of the patients. Primary outcome measures were length of stay (LOS), postoperative morbidity, readmissions, and reoperations.
  
  
  RESULTS
  Mean (SD) baseline body mass index (BMI) and age was 46.4 (6.7) kg/m(2) and 45.1 (11.2) years, respectively. Fifty-four percent of the patients were on medication for hypertension (HT) and 38 % for type 2 diabetes mellitus (DM2). Mean (SD) and median (range) surgical time was 73.8 (16.9) and 65 (40-143) min, respectively. Mean LOS was 1.3 days (1.1), median 1 day (1-14). Of all patients, 322 (83 %) were discharged on the first postoperative day (POD). Overall morbidity was 9.8 %. Three patients (0.8 %) had life-threatening complications. The readmission rate was 4.9 %, and 3.4 % of the patients had to be reoperated. With a follow-up rate of 83 % at 1 year, total weight loss (TWL) was 31 % and excess BMI loss (EBMIL) 70 %. Total remission of DM2 and HT was achieved in 70 and 42 % of the patients, respectively.
  
  
  CONCLUSIONS
  Enhanced recovery following LRYGB with ERAS programs is possible and safe even in a low volume, general hospital. Early discharge does not increase postoperative morbidity or readmissions.
authors.affiliation: Department of Surgery, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130, Vaasa, Finland.
authors.forename: Tilda
authors.initials: T
authors.lastname: Hahl
authors.affiliation: Department of Surgery, Hatanpää Hospital, Tampere, Finland.
authors.forename: Pipsa
authors.initials: P
authors.lastname: Peromaa-Haavisto
authors.affiliation: Department of Anaesthesiology, Vaasa Central Hospital, Vaasa, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Tarkiainen
authors.affiliation: Department of Endocrinology, Vaasa Central Hospital, Vaasa, Finland.
authors.forename: Otto
authors.initials: O
authors.lastname: Knutar
authors.affiliation: Department of Surgery, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130, Vaasa, Finland. mikael.victorzon@vshp.fi.|University of Turku, Turku, Finland. mikael.victorzon@vshp.fi.
authors.forename: Mikael
authors.initials: M
authors.lastname: Victorzon
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000150:complications; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D010351:Patient Discharge; D011182:Postoperative Care; D011183:Postoperative Complications / Q000601:surgery; D011184:Postoperative Period; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome
keywords: Bariatric surgery; ERAS; Enhanced recovery; Fast track; LRYGB; Outcome; Postoperative morbidity