Castagneto-Gissey Lidia, Russo Maria Francesca, Diddoro Annalisa, De Luca Maurizio, Musella Mario, Navarra Giuseppe, Piazza Luigi, Zappa Marco Antonio, Raffaelli Marco, Di Lorenzo Nicola, Casella Giovanni
Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
Dipartimento di Chirurgia Generale e Metabolica, Azienda ULSS5 Polesana, Ospedale di Rovigo, 45010, Rovigo, Italy.
Updates Surg. 2024 Oct 4. doi: 10.1007/s13304-024-02009-9.
The escalating global prevalence of bariatric procedures necessitates an enhanced focus on optimizing perioperative care for improved patient outcomes. This study focuses on the implementation of Enhanced Recovery After Bariatric Surgery (ERABS) protocols in Italian bariatric centers to optimize perioperative care. An online survey comprising 19 items was conducted in October 2023, targeting managing surgeons in 139 registered bariatric centers. This survey explored geographic and center-type variations, knowledge, and application of ERABS protocols, along with perioperative, intraoperative, and postoperative practices. Statistical analysis employed included one-way ANOVA and Tukey post hoc tests. Responses from 72 centers (51.8%) revealed a strong awareness of ERABS protocols among managing surgeons. Adherence rates varied geographically (46.3-63%) and among center types (60.8-56.3%). Perioperative practices, including the abandonment of antibiotics for perioperative prophylaxis by 77.5% of surgeons and the adoption of the TAP block technique in 69% of centers, aligned well with ERABS recommendations. However, inconsistencies were noted in abdominal drain usage (61.5% after SG; 70.5% after RYGB/OAGB), with a substantial percentage not adhering to ERABS guidelines. Intraoperative habits generally adhered to ERABS protocols, yet preferences for certain tests, particularly the methylene blue test (70.4%), deviated. Postoperative practices displayed positive trends, with early reintroduction of oral feeding (71.8%) and opioid-free pain management (71.8%). Variations existed in discharge timing and patient monitoring, indicating areas for further improvement. This study offers a comprehensive snapshot of ERABS protocol adherence in Italy, emphasizing the positive trend toward optimizing recovery and reducing patient stress. Despite variations, a majority of centers demonstrated commitment to ERABS principles. Ongoing education, interdisciplinary collaboration, and nationwide dialogue are essential for standardizing ERABS protocols and advancing bariatric-metabolic surgery outcomes in Italy.
全球减肥手术的患病率不断攀升，这就需要更加关注优化围手术期护理，以改善患者预后。本研究聚焦于在意大利减肥中心实施减肥手术后加速康复（ERABS）方案，以优化围手术期护理。2023年10月开展了一项包含19个项目的在线调查，目标是139家注册减肥中心的主刀医生。该调查探讨了地理和中心类型差异、ERABS方案的知识与应用，以及围手术期、术中及术后的做法。采用的统计分析方法包括单因素方差分析和Tukey事后检验。72家中心（51.8%）的回复显示，主刀医生对ERABS方案有较强的认知。依从率在地理区域（46.3 - 63%）和中心类型之间（60.8 - 56.3%）存在差异。围手术期做法，包括77.5%的外科医生放弃使用抗生素进行围手术期预防，以及69%的中心采用腹横肌平面阻滞技术，与ERABS建议高度一致。然而，在腹腔引流管使用方面存在不一致情况（袖状胃切除术后为61.5%；胃旁路手术/胆胰分流并十二指肠转位术后为70.5%），有相当比例的情况未遵循ERABS指南。术中习惯总体上遵循ERABS方案，但对某些检查的偏好存在偏差，尤其是亚甲蓝试验（70.4%）。术后做法呈现积极趋势，早期恢复经口进食（71.8%）和无阿片类药物疼痛管理（71.8%）。出院时间和患者监测方面存在差异，表明仍有进一步改进的空间。本研究全面展示了意大利ERABS方案的依从情况，强调了在优化康复和减轻患者应激方面的积极趋势。尽管存在差异，但大多数中心对ERABS原则表现出了承诺。持续教育、跨学科协作和全国性对话对于规范ERABS方案以及提升意大利减肥代谢手术的疗效至关重要。
