Implementing enhanced recovery after bariatric surgery protocol: a retrospective study

Proczko M, Kaska L, Twardowski P, Stepaniak P. Implementing enhanced recovery after bariatric surgery protocol: a retrospective study. J Anesth. 2016 Feb;30(1):170-3.

What is already known:

ERAS programmes have been widely shown to reduce hospital length of stay for a number of surgical specialities, particularly through early post-operative mobilisation and multi-modal analgesia. Outside of ERAS much research has looked into the benefits of non-clinical interventions – human factors – on clinician’s performance and subsequent patient outcomes across the medical field.

What this paper adds:

This brief paper demonstrates the successful implementation of an ERAS programme for bariatric surgery with reduced hospital length of stay alongside some other interesting benefits. Both operating and anaesthetic times were reduced as was the turnover time between cases. The paper does not detail the individual ERAS elements adhered to, but the programme includes a number of interventions aimed at improving the human factors of a bariatric list including a “working with a fixed team” concept whereby the surgeons, anaesthetists and circulating nurses work together on a regular basis improving the overall team’s efficiency. Cases were concentrated on specific lists during the week rather than being spread out across several lists with different teams. Although logistically challenging such interventions can improve theatre efficiency significantly alongside patient-specific outcomes.

Ben Morrison, Guildford.


Is there a role for enhanced recovery after laparoscopic bariatric surgery?

Barreca M, Renzi C, Tankel J, Shalhoub J, Sengupta N. Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center. Surg Obes Relat Dis. 2016 Jan;12(1):119-26.

What is already known:

The ERAS society has recently published guidelines for bariatric surgery (link) however there is limited research in this field.

What this paper adds:

This is a UK review of prospectively collected data from a single specialist centre (288 patients). They showed that an ERAS program was feasible and safe for this group of patients. They demonstrated a significant increase in patients being discharged on postoperative day one after undergoing laparoscopic roux-en-Y bypass (from 1.6% to almost 40%), with no increase in readmission rates. Interestingly neither ASA score or comorbidity had an influence on whether a patient would be discharged on the first post-operative day, (OR:50.95;95%CI:6.55–396.12; P 0.001).

 Chris Jones, Guildford.