The Application of ERAS for Patients Undergoing Bariatric Surgery: a Systematic Review and Meta-analysis.

The Application of Enhanced Recovery After Surgery (ERAS) for Patients Undergoing BariatricSurgery: a Systematic Review and Meta-analysis.

Zhou J, Du R, Wang L, Wang F, Li D, Tong G, Wang W, Ding X, Wang D. Obes Surg. 2021 Mar;31(3):1321-1331. 

What is already known

Since the implementation of the first ERAS guidelines for bariatric surgery, a number of studies evaluating effects of an ERAS pathway have been published. While these studies have been too small to evaluate complications or other more hard endpoints, a reduction in postoperative length of stay have been reported. Given the low complication rates of modern bariatric surgery, other outcomes such as readmission, nausea, and control of pain may be of importance.

What this paper adds

The paper describes the largest systematic review and meta-analysis on the effect of adherence with ERAS recommendations on postoperative outcomes after bariatric surgery, including 5 RCTs and 12 observational studies with 4964 patients in the ERAS group and 3218 patients in a standard care group. Despite the relatively high number of included patients, the study is still too small to evaluate postoperative complications. However, in equivalence with previous studies, length of stay was reduced in the ERAS group without any increase in the risk for complications or hospital readmission. The authors were also able to demonstrate a significant reduction in postoperative nausea and vomiting. Given the low rate of serious complications at present, these are important endpoints with an influence on recovery and patient satisfaction. Larger studies addressing other important endpoints are still needed, but given the fact that many of the most important ERAS items are generally implemented in standard care already, this may prove difficult to assess within RCTs.