Employing Enhanced Recovery Goals in Bariatric Surgery (ENERGY): a national quality improvement project using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

Employing Enhanced Recovery Goals in Bariatric Surgery (ENERGY): a national quality improvement project using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

Brethauer SA et al. Employing Enhanced Recovery Goals in Bariatric Surgery (ENERGY): a national quality improvement project using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obes Relat Dis. 2019 Nov;15(11):1977-1989. doi: 10.1016/j.soard.2019.08.024. Epub 2019 Sep 23.

What is already known:

Baraitric surgery is the most effective treatment for morbid obesity, and large numbers of these operations are performed all around the world. These are high risk patients often with comorbidities and so an ERAS pathway is ideal for these types of patients.  However the US has been relatively slow to adopt ERAS pathways

What this paper adds:

This is an interesting study. It was a national quality improvement project in the US, enrolling 36 different sites, but specifically targeted sites that already had an extended length of stay (ELOS). The ENERGY (employing enhanced recovery goals for surgery) pathway used was based on the ERAS Society guidelines for Bariatric surgery (which you can find here).

They allowed sites a six month run-in period, and found that with a comprehensive ERAS programme the rates of ELOS (defined as greater than 3 days) was significantly reduced – 8.1% vs 4.5% (p<0.01). There was no change in adverse events or readmissions. There was a slight trend towards high bleeding rates but did not reach significance and one thought was that it could have been the use of NSAIDs as part of a opiate sparing multimodal analgesia package.

Chris Jones, Guildford. @chrisnjones