Effectiveness of Implementation of an Enhanced Recovery Program in Bariatric Surgery

Introduction: While the adoption of ERAS protocols in bariatric surgery has increased, variability exists across centers, reflecting a spectrum of implementation stages. The objective of this study is to understand and increase awareness of the effectiveness of enhanced recovery after surgery (ERAS) protocols in bariatric surgery, given the specific perioperative difficulties and risks for this population. We aimed to study the association between implementation of the ERAS program in bariatric surgery and specific outcomes.

Methods: Primary bariatric patients (≥18 y old) at a single academic institution were divided into pre-ERAS and post-ERAS groups. Poisson and quantile regressions were used to examine the association between the ERAS protocol and length of stay and cost, respectively. Logistic regression was used to assess the impact of ERAS on 30-d readmissions.

Results: A total of 680 procedures were performed in the pre-ERAS cohort, compared to 1124 procedures post-ERAS. The median length of hospital stay was shorter, and median cost of surgery was lower for post-ERAS patients compared to pre-ERAS patients by 1 d (P = 0.001) and $2000, respectively. A higher proportion of patients in the pre-ERAS period had one or more unplanned readmissions compared to the post-ERAS period (P < 0.001). The ERAS protocol was associated with decreased length of stay (incidence rate ratio = 0.72, P < 0.001), decreased median cost (-$2230, P < 0.001), and lower risk of 30-d unplanned readmissions (odds ratio = 0.48, P < 0.001).

Conclusions: This study highlights the value of an enhanced recovery program in bariatric surgery, benefiting both patients and health systems.