title: Implementation of the Spanish National Enhanced Recovery Program (ERAS) in Bariatric Surgery: A Pilot Study.
abstract: BACKGROUND
  The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish fast track group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery.
  
  
  METHODS
  A multicentric prospective pilot study was performed, including 125 consecutive patients undergoing bariatric surgery at 3 Spanish hospitals between January and June 2015, after the Spanish National ERAS protocol in bariatric surgery. Compliance with the protocol, morbidity, mortality, hospital stay, and readmission were evaluated.
  
  
  RESULTS
  Bariatric techniques performed included 68 Roux-en-Y gastric bypass (54.4%) and 57 laparoscopic sleeve gastrectomy (45.6%) cases. All surgeries were laparoscopically performed with conversion in only 1 case (0.8%). Median postoperative pain evaluated by visual analogic scale 24 hours after surgery was 2 (range, 0 to 5). Postoperative nausea or vomiting appeared in 7 patients (5.6%). Complications appeared in 6 patients (4.8%). The reoperation rate was 4%. The mortality rate was 0.8%. The median hospital stay was 2 days (range, 2 to 10 d) and readmission rate was 2.4%. The compliance of all the items of the protocol was achieved in 78.4% of the patients.
  
  
  CONCLUSIONS
  The Spanish National ERAS protocol is a safe issue with a high implementation rate. It can be recommended to establish this protocol to other institutions.
authors.affiliation: *Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Madrid †Department of Surgery, Bariatric Surgery Unit, Clinical University Hospital Lozano Blesa, Zaragoza ‡Department of Anaesthesiology, General University Hospital Elche, Alicante.
authors.forename: Jaime
authors.initials: J
authors.lastname: Ruiz-Tovar
authors.forename: Pablo
authors.initials: P
authors.lastname: Royo
authors.forename: José L
authors.initials: JL
authors.lastname: Muñoz
authors.forename: Manuel
authors.initials: M
authors.lastname: Duran
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Redondo
authors.forename: Jose M
authors.initials: JM
authors.lastname: Ramirez
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D015397:Program Evaluation; D011446:Prospective Studies; D020127:Recovery of Function; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends