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Reduction in Opiate Use, Pain, Nausea, and Length of Stay After Implementation of a Bariatric Enhanced Recovery After Surgery Protocol

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Abstract

Purpose

Evaluate adherence to bariatric surgery enhanced recovery after surgery (ERAS) protocols in pre-operative, operative, and post-operative phases, and to compare opiate use, nausea control, and length of stay (LOS) versus historical controls.

Materials and Methods

A retrospective, observational cohort study was conducted to evaluate adherence to ERAS protocols and compare opiate and antiemetic use, pain intensity, and LOS versus those of traditional care (TC) patients preceding protocol implementation at Erie County Medical Center, a community-based hospital in Buffalo, NY, USA.

Results

One hundred ERAS and TC patients were compared. Patients were similar in age (42.5 years), gender (female, ~ 80%), race (~ 80 white), and BMI (47 kg/m2). The primary procedure performed was sleeve gastrectomy (89% ERAS, 86% TC). Protocol adherence was high for ERAS phases: prior to admission (85–98%), pre-operative (96–100%), operative (93–99%), post-anesthesia care unit (PACU) (55–61%), and floor (86–98%). Opiate morphine milligram equivalent (MME) was reduced in ERAS vs. TC in hospital by 73% (43.5 ± 42.4 vs. 160 ± 116; p < 0.001), discharge prescribing by 53% (34.8 ± 38.2 vs. 74 ± 125 MME; p = 0.003), and in total by 69% (78.3 ± 67.5 vs. 252 ± 160; p < 0.001). Despite lower opiate use, ERAS had lower pain intensity entering PACU (1.1 ± 1.8 vs. 1.9 ± 2.6; p < 0.011), leaving PACU (1.7 ± 1.5 vs. 2.9 ± 1.5; p < 0.001), and floor day 0 (5.0 ± 2.1 vs. 5.9 ± 1.8; p < 0.001). Fewer ERAS required antiemetic day 0 (63% vs. 94%; p < 0.001). ERAS were discharged in fewer hours than TC (41.1 ± 15.5 vs. 52.1 ± 18.9 h; p < 0.001).

Conclusions

Bariatric surgery ERAS protocols were implemented with a high rate of adherence and yielded profound reduction in operative and post-operative opiate use while improving pain control and nausea management in hospital and decreasing LOS.

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Authors and Affiliations

  1. Department of Bariatric Surgery, Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, USA

    Scott V. Monte, Shawn Cantie, Eyad Wohaibi, Christina Sanders & Nicole C. Scovazzo

  2. University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA

    Scott V. Monte & Ebne Rafi

  3. University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA

    Christina Sanders

Authors
  1. Scott V. Monte
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  2. Ebne Rafi
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  3. Shawn Cantie
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  4. Eyad Wohaibi
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  5. Christina Sanders
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  6. Nicole C. Scovazzo
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Correspondence to Eyad Wohaibi.

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Supplementary Information

ESM 1

Bariatric ERAS protocols: pre-operative, intraoperative, and PACU phases (DOCX 29 kb)

ESM 2

Bariatric ERAS protocols: floor phase (DOCX 25 kb)

ESM 3

Summary of bariatric ERAS medication protocols by phase (DOCX 20 kb)

ESM 4

Bariatric ERAS pre-operative quality checklist (DOCX 266 kb)

ESM 5

Bariatric ERAS post-operative call checklist (DOCX 306 kb)

ESM 6

Bariatric ERAS post-operative patient questionnaire (DOCX 102 kb)

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Monte, S.V., Rafi, E., Cantie, S. et al. Reduction in Opiate Use, Pain, Nausea, and Length of Stay After Implementation of a Bariatric Enhanced Recovery After Surgery Protocol. OBES SURG 31, 2896–2905 (2021). https://doi.org/10.1007/s11695-021-05338-5

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  • DOI: https://doi.org/10.1007/s11695-021-05338-5

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