Lisa A Bevilacqua1, Nabeel R Obeid2, Konstantinos Spaniolas3, Andrew Bates3, Salvatore Docimo3, Aurora Pryor4. 1. Department of Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA. 2. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA. 3. Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. 4. Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. aurora.pyror@stonybrookmedicine.edu.
Abstract
BACKGROUND: Pathways for enhanced recovery after surgery (ERAS) have been shown to improve length-of-stay (LOS) and post-operative complications across various surgical fields, however there is a lack of evidence-based studies in bariatric surgery. Specifically, the value of early feeding within an ERAS program in bariatric surgery is unclear. The objective of the current study was to determine the effect of early feeding on LOS for patients who underwent primary or revisional laparoscopic sleeve gastrectomy (LSG) and Roux-en-y gastric bypass (RYGB). METHODS: Retrospective single institution study of implementation of a new diet protocol in which initiation of oral intake changed from post-operative day 1 to day 0. LOS and 30-day events were compared. Patients were excluded if they were planned for 23-h stay, had significant intra-operative complications, or required reoperation within the same admission. Mann-Whitney U tests were done to compare LOS and chi-squared tests to compare 30-day events pre- and post-intervention. RESULTS: A total of 244 patients were included; 84.4% were primary cases. 50.8% of cases occurred prior to early feeding implementation. Median age was 43.5 years (IQR 33-53) and majority of patients were female (78.7%). Median LOS was 32.6 (IQR 30.0-50.6). Median LOS across the whole sample was shorter in the early feeding group (36.2 vs. 31.0 h; p < 0.001). This difference remained statistically significant for primary, but not revisional cases. Post-operative events at 30 days were similar between pre- and post-intervention groups. CONCLUSIONS: Early feeding the day of surgery is associated with significantly shorter LOS for patients who undergo bariatric surgery with no difference in 30-day readmissions.
BACKGROUND: Pathways for enhanced recovery after surgery (ERAS) have been shown to improve length-of-stay (LOS) and post-operative complications across various surgical fields, however there is a lack of evidence-based studies in bariatric surgery. Specifically, the value of early feeding within an ERAS program in bariatric surgery is unclear. The objective of the current study was to determine the effect of early feeding on LOS for patients who underwent primary or revisional laparoscopic sleeve gastrectomy (LSG) and Roux-en-y gastric bypass (RYGB). METHODS: Retrospective single institution study of implementation of a new diet protocol in which initiation of oral intake changed from post-operative day 1 to day 0. LOS and 30-day events were compared. Patients were excluded if they were planned for 23-h stay, had significant intra-operative complications, or required reoperation within the same admission. Mann-Whitney U tests were done to compare LOS and chi-squared tests to compare 30-day events pre- and post-intervention. RESULTS: A total of 244 patients were included; 84.4% were primary cases. 50.8% of cases occurred prior to early feeding implementation. Median age was 43.5 years (IQR 33-53) and majority of patients were female (78.7%). Median LOS was 32.6 (IQR 30.0-50.6). Median LOS across the whole sample was shorter in the early feeding group (36.2 vs. 31.0 h; p < 0.001). This difference remained statistically significant for primary, but not revisional cases. Post-operative events at 30 days were similar between pre- and post-intervention groups. CONCLUSIONS: Early feeding the day of surgery is associated with significantly shorter LOS for patients who undergo bariatric surgery with no difference in 30-day readmissions.
Authors: Ramon E Abola; Elliott Bennett-Guerrero; Michael L Kent; Liane S Feldman; Julio F Fiore; Andrew D Shaw; Julie K M Thacker; Tong J Gan; Timothy E Miller; Traci L Hedrick; Matthew D McEvoy; Michael G Mythen; Roberto Bergamaschi; Ruchir Gupta; Stefan D Holubar; Anthony J Senagore; Paul E Wischmeyer; Franco Carli; David C Evans; Sarah Guilbert; Rosemary Kozar; Aurora Pryor; Robert H Thiele; Sotiria Everett; Mike Grocott Journal: Anesth Analg Date: 2018-06 Impact factor: 5.108
Authors: Noëlle Geubbels; Sjoerd C Bruin; Yair I Z Acherman; Arnold W J M van de Laar; Marijke B Hoen; L Maurits de Brauw Journal: Obes Surg Date: 2014-03 Impact factor: 4.129
Authors: Kemal Dogan; Linda Kraaij; Edo O Aarts; Parweez Koehestanie; Edwin Hammink; Cees J H M van Laarhoven; Theo J Aufenacker; Ignace M C Janssen; Frits J Berends Journal: Obes Surg Date: 2015-01 Impact factor: 4.129
Authors: D P Lemanu; P P Singh; K Berridge; M Burr; C Birch; R Babor; A D MacCormick; B Arroll; A G Hill Journal: Br J Surg Date: 2013-01-21 Impact factor: 6.939
Authors: Peter T Hallowell; Thomas A Stellato; David A Yao; Ann Robinson; Margaret M Schuster; Kristen N Graf Journal: Am J Surg Date: 2009-03 Impact factor: 2.565