Implementing enhanced recovery after bariatric surgery protocol: a retrospective study.
While the demand for bariatric surgery is increasing, hospital capacity remains limited. The ERABS (Enhanced Recovery After Bariatric Surgery) protocol has been implemented in a number of bariatric centers. We retrospectively compared the operating room logistics and postoperative complications between pre-ERABS and ERABS periods in an academic hospital. The primary endpoint was the length of stay in hospital. The secondary endpoints were turnover times-the time required for preparing the operating room for the next case, induction time (from induction of anesthesia until a patient is ready for surgery), surgical time (duration of surgery), procedure time (duration of stay in the operating room), and the incidence of re-admissions, re-operations and complications during admission and within 30 days after surgery. Of a total of 374 patients, 228 and 146 received surgery following the pre-ERABS and ERABS protocols, respectively. The length of hospital stay was significantly shortened from 3.7 (95 % confidence interval [CI] 3.1-4.7) days to 2.1 (95 % CI 1.6-2.6) days (P < 0.001). Procedure (surgical) times were shortened by 15 (7) min and 12 (5) min for gastric bypass and gastric sleeve surgery, respectively (P < 0.001 for both), by introducing the ERABS protocol. Induction times were reduced from 15.2 (95 % CI 14.3-16.1) min to 12.5 (95 % CI 11.7-13.3) min (P < 0.001).Turnover times were shortened significantly from 38 (95 % CI 44-32) min to 11 (95 % CI 8-14) min. The incidence of re-operations, re-admissions and complications did not change.
General Surgical Clinical Hospital for Endocrinology and Transplantology at the Gdansk University of Medicine in Poland, Gdansk, Poland.
Monika
M
Proczko
General Surgical Clinical Hospital for Endocrinology and Transplantology at the Gdansk University of Medicine in Poland, Gdansk, Poland.
Lukasz
L
Kaska
Department of Clinical Anesthesiology and Intensive Therapy at the Gdansk University of Medicine in Poland, Gdansk, Poland.
Pawel
P
Twardowski
General Surgical Clinical Hospital for Endocrinology and Transplantology at the Gdansk University of Medicine in Poland, Gdansk, Poland. Pieter.stepaniak@gmail.com.|Department of Operating Rooms, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands. Pieter.stepaniak@gmail.com.
Pieter
P
Stepaniak
D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D009873:Operating Rooms; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
Bariatric surgery; Early recovery after bariatric surgery; Gastric bypass; Sleeve gastrectomy and morbid obesity