An Enhanced Recovery Protocol in Endoscopic Bariatric Therapies Decreases Post-Procedural Healthcare Utilization

Endoscopic bariatric procedures (EBTs) are associated with a high incidence of postoperative nausea and vomiting (PONV). We describe our experience with an Enhanced Recovery Protocol (ERP) program for EBTs, comparing healthcare utilization metrics before and after adoption.

We instated an ERP for all patients undergoing EBT in our institution, which consisted of intravenous fluids, antiemetics, analgesics and antibiotics peri-procedure, oral antiemetics and analgesics post-procedure, and a structured phone visit 24-48 h post-procedure. We performed a retrospective review of patients undergoing EBT before and after implementation of ERP, with the primary outcome of evaluating healthcare utilization. Healthcare utilization was defined as a visit to the Emergency Room (ER) or Infusion Treatment Centers (ITC), or an inpatient admission. Descriptive and comparative statistics were performed.

Our cohort comprised 434 patients (217 pre- and 217 post-implementation of ERP). Baseline characteristics including age, sex, weight and body mass index were similar between groups. Healthcare utilization was significantly lower in the post-implementation group (15.7% vs. 25.8%, p = 0.01), driven by elimination of ITC visits (0% vs. 4.6%, p < 0.01) and elective post-procedural hospitalizations (0% vs. 7.4%, p < 0.01).

The adoption of an ERP pathway in EBTs resulted in reduced healthcare utilization post-procedure, driven by lower ITC use and elective post-procedural hospitalizations.