Enhanced Recovery after Surgery (ERAS): a Systematic Review of Randomised Controlled Trials (RCTs) in Bariatric Surgery
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REVIEW
Enhanced Recovery after Surgery (ERAS): a Systematic Review of Randomised Controlled Trials (RCTs) in Bariatric Surgery Amilcare Parisi 1 & Jacopo Desiderio 1 & Roberto Cirocchi 2 & Stefano Trastulli 1 Received: 31 May 2020 / Revised: 6 September 2020 / Accepted: 21 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective Our aim was to conduct an up-to-date systematic review of randomised controlled trials (RCTs) to determine the benefits and harms of enhanced recovery after surgery (ERAS) programme in bariatric surgery. Methods MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library were searched for RCTs on ERAS versus standard care (SC) until April 2020. The primary endpoint was the length of hospital stay (LOS). Results Five RCTs included a total of 610 procedures. ERAS adoption is capable of significantly reducing LOS (MD of − 0.51; 95% CI − 0.92 to − 0.10; P = 0.01) and postoperative nausea and vomiting (PONV) (OR 0.42; 95% CI 0.19 to 0.95; P = 0.04). No significant differences in terms of adverse events and readmissions. Conclusions The implementation of ERAS in bariatric surgery produces a significant reduction in LOS and PONV. Keywords Randomised controlled trials . Systematic review . ERAS . Enhanced recovery aftersurgery . Bariatric surgery . Metabolic surgery . Sleeve gastrectomy . gastric bypass . Meta-analysis
Introduction Bariatric surgery represents the most effective and durable treatment for morbid obesity [1]. Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most popular bariatric surgical techniques worldwide [2]. Thanks to the widespread adoption of laparoscopic surgery and the implementation of perioperative care of obese patients, bariatric surgery stands out from other surgical fields as leading to lower morbidity and mortality and shorter lengths of hospital stay (LOS) [3–5]. Nevertheless, bariatric surgeons are still making efforts to further improve the care of bariatric patients through the application of enhanced recovery after surgery (ERAS) programmes in bariatric surgery. The objective of ERAS programmes is to incorporate evidence-based strategies into the preoperative, * Stefano Trastulli [email protected] 1
Department of Emergency and Digestive Surgery, St. Mary’s Hospital, 05100 Terni, Italy
2
Department of Surgical and Biomedical Sciences, University of Perugia, St. Mary’s Hospital, 05100 Terni, Italy
intraoperative and postoperative care plan with the aim of reducing patients’ surgical stress response and accelerating their functional recovery in order to improve quality of care, decrease complications and shorten hospital stays [6]. The application of ERAS to bariatric surgery is much more recent than in other surgical fields: ERAS Society guidelines for bariatric surgery date back only to 2016 [7]. To date, several observational studies comparing the adoption of ERAS versus standard of care (SC) in bariatric surgery have suggested that ERAS is safe and capabl
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