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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2020

01-06-2020 | Bariatric Surgery | 2019 SAGES Oral

Implementation of an enhanced recovery program for bariatric surgery

Authors: James Taylor, Joseph Canner, Carol Cronauer, Daniel Prior, Alisa Coker, Hien Nguyen, Thomas Magnuson, Gina Adrales, Michael Schweitzer

Published in: Surgical Endoscopy | Issue 6/2020

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Abstract

Introduction

Enhanced recovery after surgery (ERAS) programs have been successfully implemented in several surgical fields; however, there have been mixed results observed in bariatric surgery. Our institution implemented an enhanced recovery program with specific pre-, intra-, and post-operative protocols aimed at patients, nursing staff, and physicians. The aim of the study is to assess the effectiveness of the ERAS program.

Methods

Patients who underwent bariatric surgery prior to the implementation of the enhanced recovery program in the calendar year 2015 were compared to those who had surgery after implementation in 2017. Data for our institution was drawn from the Premier Hospital Database. Poisson and quantile regressions were used to examine the association between ERAS protocol and LOS and cost, respectively. Logistic regression was used to assess the impact of ERAS on 30-day complications and readmissions.

Results

277 bariatric surgical procedures were performed in the pre-ERAS group, compared to 348 procedures post-ERAS. While there was a 25.6% increase in volume, there was no statistical difference between the patient populations or the type of procedure performed between the 2 years. A decrease in length of stay was observed from 2.77 days in 2015 to 1.77 days in 2017 (p < 0.001), while median cost was also cut from $11,739.03 to $9482.18 (p < 0.001). 30-day readmission rate also decreased from 7.94% to 2.86% (p = 0.011). After controlling for other factors, ERAS protocol was associated with decreased LOS (IRR 0.65, p < 0.001), cost (− $2256.88, p < 0.001), and risk of 30-day readmission (OR 0.37, p = 0.011).

Conclusion

The implementation of a standardized enhanced recovery program resulted in reduced length of stay, cost, and 30-day readmissions. Total costs saved were greater than $800,000 in one calendar year. This study highlights that the value of an enhanced recovery program can be observed in bariatric surgery, benefiting both patients and hospital systems.

Graphic abstract

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Metadata
Title
Implementation of an enhanced recovery program for bariatric surgery
Authors
James Taylor
Joseph Canner
Carol Cronauer
Daniel Prior
Alisa Coker
Hien Nguyen
Thomas Magnuson
Gina Adrales
Michael Schweitzer
Publication date
01-06-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07045-w

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