Department of Bariatric Surgery, Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, USA.
University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA.
Obes Surg. 2021 Jul;31(7):2896-2905. doi: 10.1007/s11695-021-05338-5. Epub 2021 Mar 12.
Evaluate adherence to bariatric surgery enhanced recovery after surgery (ERAS) protocols in pre-operative, operative, and post-operative phases, and to compare opiate use, nausea control, and length of stay (LOS) versus historical controls.
A retrospective, observational cohort study was conducted to evaluate adherence to ERAS protocols and compare opiate and antiemetic use, pain intensity, and LOS versus those of traditional care (TC) patients preceding protocol implementation at Erie County Medical Center, a community-based hospital in Buffalo, NY, USA.
One hundred ERAS and TC patients were compared. Patients were similar in age (42.5 years), gender (female, ~ 80%), race (~ 80 white), and BMI (47 kg/m). The primary procedure performed was sleeve gastrectomy (89% ERAS, 86% TC). Protocol adherence was high for ERAS phases: prior to admission (85-98%), pre-operative (96-100%), operative (93-99%), post-anesthesia care unit (PACU) (55-61%), and floor (86-98%). Opiate morphine milligram equivalent (MME) was reduced in ERAS vs. TC in hospital by 73% (43.5 ± 42.4 vs. 160 ± 116; p < 0.001), discharge prescribing by 53% (34.8 ± 38.2 vs. 74 ± 125 MME; p = 0.003), and in total by 69% (78.3 ± 67.5 vs. 252 ± 160; p < 0.001). Despite lower opiate use, ERAS had lower pain intensity entering PACU (1.1 ± 1.8 vs. 1.9 ± 2.6; p < 0.011), leaving PACU (1.7 ± 1.5 vs. 2.9 ± 1.5; p < 0.001), and floor day 0 (5.0 ± 2.1 vs. 5.9 ± 1.8; p < 0.001). Fewer ERAS required antiemetic day 0 (63% vs. 94%; p < 0.001). ERAS were discharged in fewer hours than TC (41.1 ± 15.5 vs. 52.1 ± 18.9 h; p < 0.001).
Bariatric surgery ERAS protocols were implemented with a high rate of adherence and yielded profound reduction in operative and post-operative opiate use while improving pain control and nausea management in hospital and decreasing LOS.
评估肥胖症手术增强术后康复（ERAS）方案在术前、术中和术后阶段的依从性，并比较阿片类药物使用、恶心控制和住院时间（LOS）与历史对照。
进行了一项回顾性、观察性队列研究，以评估 ERAS 方案的依从性，并比较在纽约州布法罗市的社区医院 Erie County Medical Center 实施方案之前，阿片类药物和止吐药的使用、疼痛强度和 LOS 与传统护理（TC）患者的使用情况。
比较了 100 例 ERAS 和 TC 患者。患者在年龄（42.5 岁）、性别（女性，约 80%）、种族（约 80%白人）和 BMI（47kg/m）方面相似。主要手术为袖状胃切除术（89%ERAS，86%TC）。ERAS 各阶段的方案依从性较高：入院前（85-98%）、术前（96-100%）、手术（93-99%）、麻醉后护理单元（PACU）（55-61%）和病房（86-98%）。与 TC 相比，ERAS 组术中吗啡毫克当量（MME）减少 73%（43.5±42.4 vs. 160±116；p<0.001），出院时减少 53%（34.8±38.2 vs. 74±125 MME；p=0.003），总剂量减少 69%（78.3±67.5 vs. 252±160；p<0.001）。尽管阿片类药物用量较低，但 ERAS 组进入 PACU 时疼痛强度较低（1.1±1.8 vs. 1.9±2.6；p<0.011），离开 PACU 时疼痛强度较低（1.7±1.5 vs. 2.9±1.5；p<0.001），术后第 0 天病房疼痛强度较低（5.0±2.1 vs. 5.9±1.8；p<0.001）。需要止吐药的 ERAS 患者比例较低（63% vs. 94%；p<0.001）。ERAS 组的出院时间比 TC 组短（41.1±15.5 vs. 52.1±18.9 h；p<0.001）。
肥胖症手术 ERAS 方案的实施具有较高的依从性，并显著减少了手术和术后阿片类药物的使用，同时改善了住院期间的疼痛控制和恶心管理，并缩短了住院时间。
