Development and Implementation of an Enhanced Recovery Protocol for Bariatric Patients in a Third World Environment

Area of Science:

• Surgery
• Enhanced Recovery Protocols
• Bariatric Surgery

Background:

• Enhanced recovery protocols (ERP) are evidence-based pathways to optimize surgical patient care.
• Implementation in resource-limited settings presents unique challenges and opportunities.

Purpose of the Study:

• To develop and implement a reproducible enhanced recovery protocol for bariatric surgery.
• To evaluate the impact of this protocol on patient outcomes, including length of stay, complications, and costs in a developing country.

Main Methods:

• A prospective comparative study was conducted between "usual care" (UC) and "Fast Track" (FT) groups.
• UC group (2014-2017) received standard care; FT group (2017-2019) received the enhanced recovery protocol.
• Key outcomes analyzed: length of stay, 30-day readmissions, complications, morphine use, and cost analysis.

Main Results:

• The FT group demonstrated a significantly shorter mean hospital stay (40.3 hours) compared to the UC group (58.5 hours) (P=.0001).
• No significant differences were observed in global morbidity (P=.47) or major complications (P=.79) between groups.
• The FT group showed a statistically significant reduction in morphine use and overall costs compared to the UC group (P<.0001).

Conclusions:

• An enhanced recovery protocol is a reliable and effective strategy for bariatric surgery.
• The protocol can be successfully implemented in under-resourced environments, enhancing patient benefits and reducing healthcare costs.