Effectiveness of a stepwise implementation of enhanced recovery after bariatric surgery: our experience

This study evaluates the impact of enhanced recovery after bariatric surgery (ERABS) on length of hospital stay (LoS), postoperative pain, postoperative nausea and vomiting (PONV), adherence to ERABS protocol, postoperative complications, and readmission rates via gradual stepwise implementation. Between January 2017 and December 2018, an observational, controlled, prospective study was performed, enrolling consecutively followed patients who underwent sleeve gastrectomy. Patients were divided into two groups treated with an ERABS protocol which was implemented in two steps. In 2017, this included 12 items (subgroup B1); in 2018, two more items were introduced (subgroup B2). These results were then compared retrospectively to a control group of patients who underwent the same procedure from 2015-2016 whilst adhering to the 'traditional' treatment approach (group A). 367 patients were included. 146 patients in group A, 99 in subgroup B1 and 122 in subgroup B2. The median LoS was 4.5 days in group A, 3.8 days in B1, and 2.3 days in B2. Postoperative pain was 35.7% in group A, 35.6% in B1, and 25% in B2 (p = 0.18). The PONV rate was significantly lower in group B than in group A. Adherence to the ERABS protocol increased from 67% in group B1 to 80% in B2. No statistical difference in terms of 30-day postoperative complications rate and 30-day readmission rate was found. ERABS protocol showed significant improvement in LoS, postoperative pain, and PONV without increasing postoperative complications and readmissions, showing progressively better outcomes with a stepwise implementation.