Nigro S, Gioffrè A, Ursino S, Guccione F, Bartolo V, Barbera A, Navarra G
General Surgery and Surgical Oncology Unit, Department of Human Pathology 'Gaetano Barresi', University of Messina, Messina, Italy.
Updates Surg. 2025 Jun 27. doi: 10.1007/s13304-025-02206-0.
This study evaluates the impact of enhanced recovery after bariatric surgery (ERABS) on length of hospital stay (LoS), postoperative pain, postoperative nausea and vomiting (PONV), adherence to ERABS protocol, postoperative complications, and readmission rates via gradual stepwise implementation. Between January 2017 and December 2018, an observational, controlled, prospective study was performed, enrolling consecutively followed patients who underwent sleeve gastrectomy. Patients were divided into two groups treated with an ERABS protocol which was implemented in two steps. In 2017, this included 12 items (subgroup B1); in 2018, two more items were introduced (subgroup B2). These results were then compared retrospectively to a control group of patients who underwent the same procedure from 2015-2016 whilst adhering to the 'traditional' treatment approach (group A). 367 patients were included. 146 patients in group A, 99 in subgroup B1 and 122 in subgroup B2. The median LoS was 4.5 days in group A, 3.8 days in B1, and 2.3 days in B2. Postoperative pain was 35.7% in group A, 35.6% in B1, and 25% in B2 (p = 0.18). The PONV rate was significantly lower in group B than in group A. Adherence to the ERABS protocol increased from 67% in group B1 to 80% in B2. No statistical difference in terms of 30-day postoperative complications rate and 30-day readmission rate was found. ERABS protocol showed significant improvement in LoS, postoperative pain, and PONV without increasing postoperative complications and readmissions, showing progressively better outcomes with a stepwise implementation.
本研究通过逐步实施评估减重手术后加速康复（ERABS）对住院时间（LoS）、术后疼痛、术后恶心呕吐（PONV）、ERABS方案依从性、术后并发症及再入院率的影响。2017年1月至2018年12月，进行了一项观察性、对照、前瞻性研究，连续纳入接受袖状胃切除术的患者。患者分为两组，采用分两步实施的ERABS方案进行治疗。2017年，该方案包括12项内容（B1亚组）；2018年，又增加了两项内容（B2亚组）。然后将这些结果与2015 - 2016年接受相同手术并遵循“传统”治疗方法的对照组患者（A组）进行回顾性比较。共纳入367例患者。A组146例，B1亚组99例，B2亚组122例。A组LoS中位数为4.5天，B1组为3.8天，B2组为2.3天。A组术后疼痛发生率为35.7%，B1组为35.6%，B2组为25%（p = 0.18）。B组PONV发生率显著低于A组。ERABS方案的依从性从B1组的67%提高到B2组的80%。术后30天并发症发生率和30天再入院率无统计学差异。ERABS方案在LoS、术后疼痛和PONV方面有显著改善，且未增加术后并发症和再入院率，逐步实施显示出越来越好的结果。
