An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative day 1?

Lam J et al. An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative
day 1? Surg Endosc. 2019 Feb;33(2):580-586.

What is already known:

The ERAS society published guidelines for Bariatric surgery in 2016 [they can be found here]. Bariatric surgery has been shown to help improve or resolve many obesity-related conditions, such as type 2 diabetes, high blood pressure, heart disease, and more. Laparoscopic Sleeve Gastrectomy is one of the most commonly performed bariatric operations in the USA.

What this paper adds:

This was a single centre retrospective review of their programme after it had been introduced. They included over 200 patients and with a comprehensive ERAS pathway they showed that after laparoscopic surgery patients could be safely discharged on postoperative day 1. With no difference in readmission rates, post-operative complications or mortality. They also found with a good multimodal analgesic programme they could reduce intraoperative opioid use and still reduced pain scores on postoperative day 1.

Chris Jones, Guildford.


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.