title: Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy.
abstract: OBJECTIVE
  To assess the safety of enhanced recovery after surgery (ERAS) program in gastrectomy and influences on nutrition state and insulin-resistance.
  
  
  METHODS
  Our ERAS program involved shortening the fasting periods and preoperative carbohydrate loading. Eighty gastrectomy patients were randomly assigned to either the conventional group (CG) or ERAS group (EG). We assessed the clinical characteristics and postoperative outcomes prospectively. The primary endpoint was noninferiority in timely discharge from the hospital within 12 d. Secondary endpoints were the incidence of aspiration at anesthesia induction, incidence of postoperative complications, health related quality of life (HRQOL) using the SF8 Health Survey questionnaire, nutrition state [e.g., albumin, transthyretin (TTR), retinal-binding protein (RBP), and transferrin (Tf)], the homeostasis model assessment-insulin resistance (HOMA-R) index, postoperative urine volume, postoperative weight change, and postoperative oral intake.
  
  
  RESULTS
  The ERAS program was noninferior to the conventional program in achieving discharge from the hospital within 12 d (95.0% vs 92.5% respectively; 95%CI: -10.0%-16.0%). There was no significant difference in postoperative morbidity between the two groups. Adverse events such as vomiting and aspiration associated with the induction of general anesthesia were not observed. There were no significant differences with respect to postoperative urine volume, weight change, and oral intake between the two groups. EG patients with preoperative HOMA-R scores above 2.5 experienced significant attenuation of their HOMA-R scores on postoperative day 1 compared to CG patients (P = 0.014). There were no significant differences with respect to rapid turnover proteins (TTR, RBP and Tf) or HRQOL scores using the SF8 method.
  
  
  CONCLUSIONS
  Applying the ERAS program to patients who undergo gastrectomy is safe, and improves insulin resistance with no deterioration in QOL.
authors.affiliation: Nobuaki Fujikuni, Kazuaki Tanabe, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima 734-8551, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Fujikuni
authors.affiliation: Nobuaki Fujikuni, Kazuaki Tanabe, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima 734-8551, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Tanabe
authors.affiliation: Nobuaki Fujikuni, Kazuaki Tanabe, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima 734-8551, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Tokumoto
authors.affiliation: Nobuaki Fujikuni, Kazuaki Tanabe, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima 734-8551, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Nobuaki Fujikuni, Kazuaki Tanabe, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima 734-8551, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Hattori
authors.affiliation: Nobuaki Fujikuni, Kazuaki Tanabe, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima 734-8551, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Misumi
authors.affiliation: Nobuaki Fujikuni, Kazuaki Tanabe, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima 734-8551, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
keywords: Carbon hydrogen oxygen; Enhanced recovery after surgery; Gastrectomy; Insulin resistance; Randomized controlled trial