Banner - University Medical Center, Department of Surgery, University of Arizona, 1501 N. Campbell Avenue, PO Box 245066, Tucson, AZ, 85724, USA.
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Obes Surg. 2019 Feb;29(2):492-498. doi: 10.1007/s11695-018-3579-z.
The implementation of Enhanced Recovery After Surgery (ERAS) guidelines has been widely studied among various surgical specialties. We aimed at comparing the perioperative outcomes and compliance with ERAS protocol in bariatric surgery at our center.
An observational review of a prospectively maintained database was performed. Patients who underwent primary bariatric surgery (gastric bypass or sleeve gastrectomy) between January 2011 and June 2018 were included. Patients were divided into pre- and post-ERAS groups. Data including basic demographic information, length of hospital stay, 30-day perioperative complications, and readmission rates were collected. Compliance with elements of ERAS was assessed using a combination of chart review and a prospectively implemented checklist. P < 0.05 was chosen to be statistically significant.
A total of 435 patients were included: 239 patients in the pre-ERAS group and 196 patients in the post-ERAS group. There were no statistical differences in baseline demographics and major comorbidities between the 2 groups. The post-ERAS group had shorter length of hospital stay (2.23 vs 1.23, p < 0.001) and lower rates of 30-day postoperative morbidity (8.7 vs 4%, p = .04). There was no significant difference between the 2 groups with respect to readmissions rates. There was no mortality in either group. Overall compliance rates with ERAS elements were 85%; compliance increased significantly with the implementation of a checklist (p < 0.001).
Implementation of ERAS program for bariatric surgery is safe and feasible. It reduces hospital stay and postoperative morbidity. Easy to implement strategies such as checklists should be encouraged in bariatric programs to aid in implementation and compliance with ERAS elements for perioperative care.
加速康复外科（ERAS）指南的实施已在多个外科专业中得到广泛研究。我们旨在比较我院减重手术围手术期结果和 ERAS 方案的依从性。
对前瞻性维护的数据库进行观察性回顾。纳入 2011 年 1 月至 2018 年 6 月期间行初次减重手术（胃旁路术或袖状胃切除术）的患者。患者分为 ERAS 前组和 ERAS 后组。收集基本人口统计学信息、住院时间、30 天围手术期并发症和再入院率。通过图表审查和前瞻性实施的检查表评估 ERAS 元素的依从性。选择 P < 0.05 为统计学显著。
共纳入 435 例患者：ERAS 前组 239 例，ERAS 后组 196 例。两组患者的基线人口统计学和主要合并症无统计学差异。ERAS 后组住院时间更短（2.23 天 vs 1.23 天，P < 0.001），30 天术后发病率较低（8.7% vs 4%，P = 0.04）。两组患者的再入院率无统计学差异。两组均无死亡病例。ERAS 元素的总体依从率为 85%；实施检查表后依从率显著提高（P < 0.001）。
ERAS 方案在减重手术中的实施是安全可行的。它可以缩短住院时间和术后发病率。应鼓励在减重计划中实施检查表等易于实施的策略，以帮助实施和遵守围手术期 ERAS 要素。
