The Impact of an Enhanced Recovery Protocol for Patients Undergoing Laparoscopic Revisional Bariatric Surgery
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BRIEF COMMUNICATION
The Impact of an Enhanced Recovery Protocol for Patients Undergoing Laparoscopic Revisional Bariatric Surgery Kevin Bree 1
&
John Mitko 1 & Lala Hussain 2 & Kevin Tymitz 1 & George Kerlakian 1 & Katherine Meister 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Enhanced Recovery After Surgery (ERAS) protocols have been instituted in various subspecialties of surgery. This study aims to provide evidence that ERAS protocols are safe and feasible in revisional bariatric surgery. A retrospective chart review was performed for all patients who underwent conversion from laparoscopic gastric band (LAGB) or sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) from January 2016 to February 2018 at a single independent academic medical center. We calculated the average LOS for these patients as well as the 30-day readmission and 30-day reoperation rates. Median length of stay (LOS) was 1 day (range 1–5) with 92.9% of all patients leaving by postoperative day 3. No patients were readmitted to the hospital within 30 days and none required reoperation. Keywords Bariatric surgery . Enhanced recovery after surgery . Revision . Revisional bariatric surgery
Introduction Enhanced Recovery after Surgery (ERAS) protocols are utilized to standardize perioperative patient care in an effort to improve patient outcomes. These protocols are designed to hasten recovery by minimizing the stress response of surgery, improve pain control, accelerate gastrointestinal function, and minimize hospital length of stay (LOS). A meta-analysis of randomized controlled trials evaluating ERAS in patients undergoing colon and rectal surgery revealed a faster return of gastrointestinal function as well as decreased LOS and complication rates without compromising patient safety [1]. In patients undergoing bariatric surgery, Awad et al. found that a strict ERAS protocol was associated with a shorter LOS, improved follow-up, and acceptable 30-day readmission rates, and was cost-effective without increased morbidity [2]. Factors shown to negatively affect discharge on postoperative day one after laparoscopic sleeve gastrectomy include preoperative opioid use,
* Kevin Bree [email protected] 1
Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH 45220, USA
2
Trihealth Hatton Research Institute, Cincinnati, OH, USA
history of psychiatric illness, chronic kidney disease, and revision cases [3]. Furthermore, a LOS less than 24 h in patients undergoing sleeve gastrectomy has been demonstrated to be safe and feasible [4]. Although the concept of ERAS has been around since the 1990s, the bariatric ERAS pathway is more recently being adopted into clinical practice. There is currently little evidence on the impact of ERAS on patients undergoing revisional bariatric surgery. The purpose of our study was to determine if the use of ERAS is safe and feasible in patients undergoing revisional bariatric surgery in a community hospital setting. The patients in this study underwent laparoscopic conversio
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