BACKGROUND: Enhanced recovery after surgery (ERAS) guidelines, fast-track protocols, and alternative clinical pathways have been widely promoted in a variety of disciplines leading to improved outcomes in post-operative morbidity and length of stay (LOS). This meta-analysis assesses the implications of standardized management protocols in bariatric surgery. METHODS: The PRISMA guidelines were adhered to. Databases were searched with the application of pre-defined inclusion and exclusion criteria. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Individual protocols and surgical approaches were assessed through subgroup analysis, and sensitivity analysis of methodological quality was performed. RESULTS: A total of 1536 studies were screened; 13 studies were eventually included for meta-analysis involving a total of 6172 patients. Standardized perioperative techniques were associated with a savings of 19.5 min in operative time (p < 0.01), as well as a LOS which was shortened by 1.5 days (p < 0.01). Pooled post-operative morbidity rates also favored enhanced recovery care protocols (OR 0.7%, 95% CI 0.6-0.9%, p < 0.01). CONCLUSION: Bariatric surgery involves a complex cohort of patients who require high-quality evidence-based care to improve outcomes. Consensus guidelines on the feasibility of ERAS and alternative clinical pathways are required in the setting of bariatric surgery.
BACKGROUND: Enhanced recovery after surgery (ERAS) guidelines, fast-track protocols, and alternative clinical pathways have been widely promoted in a variety of disciplines leading to improved outcomes in post-operative morbidity and length of stay (LOS). This meta-analysis assesses the implications of standardized management protocols in bariatric surgery. METHODS: The PRISMA guidelines were adhered to. Databases were searched with the application of pre-defined inclusion and exclusion criteria. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Individual protocols and surgical approaches were assessed through subgroup analysis, and sensitivity analysis of methodological quality was performed. RESULTS: A total of 1536 studies were screened; 13 studies were eventually included for meta-analysis involving a total of 6172 patients. Standardized perioperative techniques were associated with a savings of 19.5 min in operative time (p < 0.01), as well as a LOS which was shortened by 1.5 days (p < 0.01). Pooled post-operative morbidity rates also favored enhanced recovery care protocols (OR 0.7%, 95% CI 0.6-0.9%, p < 0.01). CONCLUSION: Bariatric surgery involves a complex cohort of patients who require high-quality evidence-based care to improve outcomes. Consensus guidelines on the feasibility of ERAS and alternative clinical pathways are required in the setting of bariatric surgery.
Authors: Arman Kahokehr; Tarik Sammour; Kamran Zargar-Shoshtari; Lisa Thompson; Andrew G Hill Journal: Int J Surg Date: 2008-12-03 Impact factor: 6.071
Authors: Guido H H Mannaerts; Stefanie R van Mil; Pieter S Stepaniak; Martin Dunkelgrün; Marcel de Quelerij; Serge J Verbrugge; Hans F Zengerink; L Ulas Biter Journal: Obes Surg Date: 2016-02 Impact factor: 4.129
Authors: A Thorell; A D MacCormick; S Awad; N Reynolds; D Roulin; N Demartines; M Vignaud; A Alvarez; P M Singh; D N Lobo Journal: World J Surg Date: 2016-09 Impact factor: 3.352
Authors: Sebastiaan W Polle; Jan Wind; Jan W Fuhring; Jan Hofland; Dirk J Gouma; Willem A Bemelman Journal: Dig Surg Date: 2007-09-13 Impact factor: 2.588
Authors: Rob McCarney; James Warner; Steve Iliffe; Robbert van Haselen; Mark Griffin; Peter Fisher Journal: BMC Med Res Methodol Date: 2007-07-03 Impact factor: 4.615
Authors: Emma C Kearns; Naomi M Fearon; Pauric O'Reilly; Cian Lawton; Tim McMackin; Abigail M Walsh; Justin Geogheghan; Helen M Heneghan Journal: Obes Surg Date: 2021-01-08 Impact factor: 4.129
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: Amlish B Gondal; Chiu-Hsieh Hsu; Federico Serrot; Andrea Rodriguez-Restrepo; Audriana N Hurbon; Carlos Galvani; Iman Ghaderi Journal: Obes Surg Date: 2019-02 Impact factor: 4.129
Authors: Piotr Małczak; Magdalena Pisarska; Michał Wysocki; Piotr Major; Michał Pędziwiatr Journal: J Gastrointest Surg Date: 2018-05-31 Impact factor: 3.452