Tilda Hahl1, Pipsa Peromaa-Haavisto2, Pekka Tarkiainen3, Otto Knutar4, Mikael Victorzon5,6. 1. Department of Surgery, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130, Vaasa, Finland. 2. Department of Surgery, Hatanpää Hospital, Tampere, Finland. 3. Department of Anaesthesiology, Vaasa Central Hospital, Vaasa, Finland. 4. Department of Endocrinology, Vaasa Central Hospital, Vaasa, Finland. 5. Department of Surgery, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130, Vaasa, Finland. mikael.victorzon@vshp.fi. 6. University of Turku, Turku, Finland. mikael.victorzon@vshp.fi.
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS) programs are well established for patients undergoing colorectal surgery. Relatively little is known about ERAS following bariatric surgery in general or following laparoscopic Roux-en-Y gastric bypass (LRYGB) in particular. PATIENTS AND METHODS: This is a prospective, observational study of 388 consecutive patients that underwent LRYGB with ERAS in a general hospital. The ERAS protocol included standardizations of pre-, intra-, and postoperative modalities in order to reduce the stress response of the patients. Primary outcome measures were length of stay (LOS), postoperative morbidity, readmissions, and reoperations. RESULTS: Mean (SD) baseline body mass index (BMI) and age was 46.4 (6.7) kg/m(2) and 45.1 (11.2) years, respectively. Fifty-four percent of the patients were on medication for hypertension (HT) and 38 % for type 2 diabetes mellitus (DM2). Mean (SD) and median (range) surgical time was 73.8 (16.9) and 65 (40-143) min, respectively. Mean LOS was 1.3 days (1.1), median 1 day (1-14). Of all patients, 322 (83 %) were discharged on the first postoperative day (POD). Overall morbidity was 9.8 %. Three patients (0.8 %) had life-threatening complications. The readmission rate was 4.9 %, and 3.4 % of the patients had to be reoperated. With a follow-up rate of 83 % at 1 year, total weight loss (TWL) was 31 % and excess BMI loss (EBMIL) 70 %. Total remission of DM2 and HT was achieved in 70 and 42 % of the patients, respectively. CONCLUSION: Enhanced recovery following LRYGB with ERAS programs is possible and safe even in a low volume, general hospital. Early discharge does not increase postoperative morbidity or readmissions.
BACKGROUND: Enhanced recovery after surgery (ERAS) programs are well established for patients undergoing colorectal surgery. Relatively little is known about ERAS following bariatric surgery in general or following laparoscopic Roux-en-Y gastric bypass (LRYGB) in particular. PATIENTS AND METHODS: This is a prospective, observational study of 388 consecutive patients that underwent LRYGB with ERAS in a general hospital. The ERAS protocol included standardizations of pre-, intra-, and postoperative modalities in order to reduce the stress response of the patients. Primary outcome measures were length of stay (LOS), postoperative morbidity, readmissions, and reoperations. RESULTS: Mean (SD) baseline body mass index (BMI) and age was 46.4 (6.7) kg/m(2) and 45.1 (11.2) years, respectively. Fifty-four percent of the patients were on medication for hypertension (HT) and 38 % for type 2 diabetes mellitus (DM2). Mean (SD) and median (range) surgical time was 73.8 (16.9) and 65 (40-143) min, respectively. Mean LOS was 1.3 days (1.1), median 1 day (1-14). Of all patients, 322 (83 %) were discharged on the first postoperative day (POD). Overall morbidity was 9.8 %. Three patients (0.8 %) had life-threatening complications. The readmission rate was 4.9 %, and 3.4 % of the patients had to be reoperated. With a follow-up rate of 83 % at 1 year, total weight loss (TWL) was 31 % and excess BMI loss (EBMIL) 70 %. Total remission of DM2 and HT was achieved in 70 and 42 % of the patients, respectively. CONCLUSION: Enhanced recovery following LRYGB with ERAS programs is possible and safe even in a low volume, general hospital. Early discharge does not increase postoperative morbidity or readmissions.
Authors: U O Gustafsson; M J Scott; W Schwenk; N Demartines; D Roulin; N Francis; C E McNaught; J Macfie; A S Liberman; M Soop; A Hill; R H Kennedy; D N Lobo; K Fearon; O Ljungqvist Journal: World J Surg Date: 2013-02 Impact factor: 3.352
Authors: Colette S Inaba; Christina Y Koh; Sarath Sujatha-Bhaskar; Lishi Zhang; Ninh T Nguyen Journal: J Am Coll Surg Date: 2018-02-08 Impact factor: 6.113
Authors: Hugo Meunier; Yannick Le Roux; Anne-Lise Fiant; Yoann Marion; Adrien Lee Bion; Thomas Gautier; Nicolas Contival; Jean Lubrano; Fabienne Fobe; Marion Zamparini; Marie-Astrid Piquet; Véronique Savey; Arnaud Alves; Benjamin Menahem Journal: Obes Surg Date: 2019-09 Impact factor: 4.129
Authors: Jarrod M Buzalewski; Mark E Mahan; Marcus Fluck; James Dove; Ryan D Horsley; David M Parker; Anthony T Petrick; Jon D Gabrielsen Journal: Obes Surg Date: 2019-08 Impact factor: 4.129