Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis

Piotr Małczak, Magdalena Pisarska, Major Piotr, Michał Wysocki, Andrzej Budzyński, Michał Pędziwiatr, Piotr Małczak, Magdalena Pisarska, Major Piotr, Michał Wysocki, Andrzej Budzyński, Michał Pędziwiatr

Abstract

Enhanced recovery after surgery (ERAS) protocol is well established in many surgical disciplines and leads to a decrease in the length of hospital stay and morbidity. Multimodal protocols have also been introduced to bariatric surgery. This review aims to evaluate the current literature on ERAS in obesity surgery and to conduct a meta-analysis of primary and secondary outcomes. MEDLINE, Embase, Scopus and Cochrane Library were searched for eligible studies. Key journals were hand-searched. We analysed data up to May 2016. Eligible studies had to contain four described ERAS protocol elements. The primary outcome was the length of hospital stay; the secondary outcomes included overall morbidity, specific complications, mortality, readmissions and costs. Random effect meta-analyses were undertaken. The initial search yielded 1151 articles. Thorough evaluation resulted in 11 papers, which were analysed. The meta-analysis of the length of stay presented a significant reduction standard mean difference (Std. MD) = -2.39 (-3.89, -0.89), p = 0.002. The analysis of overall morbidity, specific complications and Clavien-Dindo classification showed no significant variations among the study groups. ERAS protocol in bariatric surgery leads to the reduction of the length of hospital stay while maintaining no or low influence on morbidity.

Keywords: Bariatric surgery; ERAS; Gastric bypass; Sleeve gastrectomy.

Conflict of interest statement

The authors declare that they have no conflict of interest. Ethical Approval For this type of study, formal consent is not required. Informed Consent Does not apply.

Figures

Fig. 1
Fig. 1
Study selection flow chart
Fig. 2
Fig. 2
Pooled estimates of the length of hospital stay comparing enhanced recovery after surgery vs. standard care. CI confidence interval, df degrees of freedom
Fig. 3
Fig. 3
Pooled estimates of overall morbidity comparing enhanced recovery after surgery vs. standard care. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 4
Fig. 4
Pooled estimates of minor complications comparing enhanced recovery after surgery vs. standard care. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 5
Fig. 5
Pooled estimates of major complications comparing enhanced recovery after surgery vs. standard care. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 6
Fig. 6
Pooled estimates of suture line leakage events comparing enhanced recovery after surgery vs. standard care. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 7
Fig. 7
Pooled estimates of bleeding events comparing enhanced recovery after surgery vs. standard care. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 8
Fig. 8
Pooled estimates of cardiopulmonary complications comparing enhanced recovery after surgery vs. standard care. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 9
Fig. 9
Pooled estimates of hospital readmission comparing enhanced recovery after surgery vs. standard care. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 10
Fig. 10
Pooled estimates of treatment costs comparing enhanced recovery after surgery vs. standard care. CI confidence interval, df degrees of freedom
Fig. 11
Fig. 11
Protocol implementation pathway based on ERAS Society programme

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Source: PubMed

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