Hugo Meunier1, Yannick Le Roux1, Anne-Lise Fiant2, Yoann Marion1, Adrien Lee Bion1, Thomas Gautier3, Nicolas Contival4, Jean Lubrano1,5, Fabienne Fobe2, Marion Zamparini2, Marie-Astrid Piquet6, Véronique Savey6, Arnaud Alves1,5, Benjamin Menahem7,8. 1. Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France. 2. Department of Anesthesia, University Hospital of Caen, Caen, France. 3. Clinique Saint Jean, 36 avenue Buisson Bertrand, 34093, Montpellier, France. 4. Groupe Hospitalier Mutualiste, 8 rue du Dr Calmette, 38000, Grenoble, France. 5. UNICAEN, INSERM, ANTICIPE, Normandie Univ, 14000, Caen, France. 6. Department of Nutrition, University Hospital of Caen, Caen, France. 7. Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France. menahem-b@chu-caen.fr. 8. UNICAEN, INSERM, ANTICIPE, Normandie Univ, 14000, Caen, France. menahem-b@chu-caen.fr.
Abstract
BACKGROUND: The aim of this study was to investigate whether the implementation of enhanced recovery after surgery (ERAS) guidelines according to Thorell and co. in our tertiary referral bariatric center might improve post-operative outcomes. METHODS: ERAS program was introduced in our center since January 1, 2017. Retrospective review of a prospectively collected database identified patients who underwent laparoscopic primary and revisional bariatric surgeries from October 2005 to January 2018. Patients exposed to ERAS program ("ERAS group") were matched in a 1:1 ratio with patients exposed to conventional care (control group) using a propensity score based on age, gender, preoperative body mass index (BMI), diabetes mellitus, and the type of procedures. The primary outcome was total hospital length of stay (LOS) and the secondary outcomes included the post-operative complications and readmission rates. RESULTS: During the study period, 464 patients were included, 232 in each group. Implementation of the ERAS protocol was significantly associated with a reduction of LOS (2.47 ± 1.7 vs 5.39 ± 1.9 days, p < 0.00001). One-third of patients was discharged (77/232, 33%) on the first postoperative day (POD) and more than three quarter of patients on POD 2 (182/232, 77%). At the opposite, no patients of the control group were discharged on POD 2. Overall 30-day and 90-day morbidity and readmission rates were the same in both groups. There was no death in each group. CONCLUSIONS: This large case-matched study using a propensity score analysis suggests that implementation of ERAS program significantly reduced length of hospital stay without significant increases on overall morbidity, and readmission rates.
BACKGROUND: The aim of this study was to investigate whether the implementation of enhanced recovery after surgery (ERAS) guidelines according to Thorell and co. in our tertiary referral bariatric center might improve post-operative outcomes. METHODS: ERAS program was introduced in our center since January 1, 2017. Retrospective review of a prospectively collected database identified patients who underwent laparoscopic primary and revisional bariatric surgeries from October 2005 to January 2018. Patients exposed to ERAS program ("ERAS group") were matched in a 1:1 ratio with patients exposed to conventional care (control group) using a propensity score based on age, gender, preoperative body mass index (BMI), diabetes mellitus, and the type of procedures. The primary outcome was total hospital length of stay (LOS) and the secondary outcomes included the post-operative complications and readmission rates. RESULTS: During the study period, 464 patients were included, 232 in each group. Implementation of the ERAS protocol was significantly associated with a reduction of LOS (2.47 ± 1.7 vs 5.39 ± 1.9 days, p < 0.00001). One-third of patients was discharged (77/232, 33%) on the first postoperative day (POD) and more than three quarter of patients on POD 2 (182/232, 77%). At the opposite, no patients of the control group were discharged on POD 2. Overall 30-day and 90-day morbidity and readmission rates were the same in both groups. There was no death in each group. CONCLUSIONS: This large case-matched study using a propensity score analysis suggests that implementation of ERAS program significantly reduced length of hospital stay without significant increases on overall morbidity, and readmission rates.
Entities:
Keywords:
ERAS program; Laparoscopic bariatric surgery; Length of stay
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