Bariatric Enhanced Recovery Protocol: a Community Quality Perspective
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Bariatric Enhanced Recovery Protocol: a Community Quality Perspective Nicholas Gastaldo 1 & Ryan Fitzgerald 1 & Kelly Bahr 2 & Joseph N. Gabra 3 & Lance Talmage 4 & Walter Chlysta 5 & Christopher R. Daigle 1 Received: 29 May 2020 / Revised: 10 November 2020 / Accepted: 11 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Bariatric enhanced recovery protocols can decrease length of stay (LOS) and hospital costs without compromising patient safety. Increased data is needed to compare patient outcomes before and after application of enhanced recovery pathways. We present a bariatric enhanced recovery protocol (BERP) at a community hospital. The objectives were to decrease hospital LOS and reduce schedule II substance use (medications with a high potential for abuse, potentially resulting in psychological or physical dependence), without compromising patient safety. Methods This was a combined retrospective and prospective analysis of all patients undergoing bariatric surgery by two surgeons from September 2016 to April 2018. Mann-Whitney U, Pearson chi-square, and Fisher’s exact tests were used to compare demographics, comorbidities, and outcomes. Results Two hundred patients were evaluated. Overall median (interquartile range) age was 43.0 (36.0–54.0) years and body mass index (BMI) was 45.0 (40.6–50.3) kg/m2. Pre-protocol mean hospital LOS was 2.3 days while enhanced recovery protocol patients mean LOS was 1.4 days (p < 0.001). Sixty-five percent of BERP patients were discharged on hospital day 1, while no patients prior to the protocol were discharged before hospital day 2. Only 9% of BERP patients were discharged with schedule II medications, compared to 100% of the pre-protocol patients (p < 0.001). Intraoperative, in-hospital, and 30-day complication rates were not statistically significant between the two groups. Conclusion Community hospitals can reduce length of stay and narcotic prescribing without compromising safety-related outcomes. Significant reductions in the amount of schedule II medications can be achieved when using multimodal enhanced recovery protocol approaches. Keywords Enhanced recovery protocol . Length of stay . Bariatric surgery . Opiate use reduction
Introduction * Nicholas Gastaldo [email protected] 1
Department of General Surgery, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH, USA
2
Department of Care Management, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH, USA
3
Department of Research, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH, USA
4
Department of Anesthesiology, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH, USA
5
Department of Bariatric and General Surgery, Western Reserve Hospital, 1900 23rd St, Cuyahoga Falls, OH, USA
Comprehensive recommendations for efficient perioperative care of bariatric patients are necessary to reduce hospital costs, LOS, and curb postoperative narcotic use in the face of a growing opiate epidemic [1
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