Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA.
Surg Endosc. 2023 Jul;37(7):5421-5429. doi: 10.1007/s00464-023-10027-8. Epub 2023 Apr 5.
Enhanced recovery after bariatric surgery pathways are associated with improved postoperative outcomes. This study aims to assess efficacy and safety of three novel protocol contributions (transversus abdominis plane blocks, ketamine and fosaprepitant), as well as their impact on length of stay (LOS) and on postoperative complications.
Effectiveness and safety were retrospectively investigated in patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) over a 6-year period in a single institution. Group 1 patients were not exposed to any of our suggested interventions, whereas Group 2 were exposed to all of three.
Between January 2015 and August 2021, 1480 patients underwent primary SG (77.6%) or RYGB (22.4%); of those, 1132 (76.5%) and 348 (23.5%) were in Groups 1 and 2, respectively. Mean BMI and age were 45.87 versus 43.65 kg/m and 45.53 versus 44.99 years in groups 1 and 2, respectively. Suggested interventions were associated with lower operative times (84.79 ± 24.21 vs. 80.78 ± 32.8 min, p = 0.025). In Group 2, the mean LOS decreased in 0.18 day (1.79 ± 1.04 vs. 1.60 ± 0.90; p = 0.004). Overall complication rates were 8% and 8.6% for groups 1 and 2, respectively; readmission rates were 5.7% (64 pts) vs. 7.2% (25 pts), p > 0.05. Reoperations were less prevalent in Group 2 (1.5% vs. 1.1%; p = 0.79).
Focus on optimized pain management, allied to a superior PONV control, may be relevant contributors for a lower LOS without negative impacts in complications rates.
减重手术后的加速康复路径与改善术后结果相关。本研究旨在评估三种新型方案贡献（腹横肌平面阻滞、氯胺酮和福沙匹坦）的疗效和安全性，以及它们对住院时间（LOS）和术后并发症的影响。
在一家单中心机构，对 6 年内接受 Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）的患者进行了回顾性疗效和安全性研究。第 1 组患者未接受任何建议的干预措施，而第 2 组患者则接受了三种方案的全部干预措施。
2015 年 1 月至 2021 年 8 月，共 1480 例患者接受了原发性 SG（77.6%）或 RYGB（22.4%）手术；其中 1132 例（76.5%）和 348 例（23.5%）患者分别在第 1 组和第 2 组。第 1 组和第 2 组患者的平均 BMI 和年龄分别为 45.87kg/m²和 45.53 岁。与第 1 组相比，第 2 组患者的手术时间更短（84.79±24.21 分钟比 80.78±32.8 分钟，p=0.025）。在第 2 组中，平均 LOS 减少了 0.18 天（1.79±1.04 天比 1.60±0.90 天，p=0.004）。第 1 组和第 2 组的总体并发症发生率分别为 8%和 8.6%；再入院率分别为 5.7%（64 例）和 7.2%（25 例），p＞0.05。第 2 组的再次手术发生率较低（1.5%比 1.1%，p=0.79）。
关注优化疼痛管理，以及更好的术后恶心和呕吐（PONV）控制，可能是降低 LOS 的重要因素，且不会对并发症发生率产生负面影响。
