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Impact of Adherence to the ERAS® Protocol on Short-term Outcomes after Bariatric Surgery

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Abstract

Introduction

Enhanced recovery after surgery had been introduced with success in many surgical fields, including bariatrics. There are numerous studies presenting how ERAS® has positively affected the outcomes following weight loss surgery. The effect of compliance with the protocol on postoperative results has not been extensively researched in the literature.

Methodology

The 15-element protocol used in our department was analyzed, and compliance was calculated based on pre- and peri-operative elements. We gathered data on recovery parameters, complications, and length of hospital stay. Patients were divided into two groups according to their compliance: group 1 < 80%, group 2 > 80%. Multivariate analysis was used to determine which element had the greatest effect.

Results

Our study group consisted of 764 patients operated in between 2009 and 2017. The median compliance was 87.94%; group 1 had 68.1% compliance and group 2 reached 92.7%. There were significant differences in morbidity (group 1 13.6% vs. group 2 2.8%, p < 0.001) and length of hospital stay (4 vs. 3 days, p < 0.001). Compliance, early mobilization, and day of food tolerance have been identified as affecting morbidity, whereas for prolonged hospital stays, it was multimodal analgesia, food tolerance, the volume of oral fluids, and intravenous fluids.

Conclusions

Compliance with the ERAS® protocol affects morbidity and length of hospital stay. More studies are required to establish which elements have the greatest impact and which are essential.

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Authors and Affiliations

  1. 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Krakow, Poland

    Piotr Małczak, Michał Wysocki, Hanna Twardowska, Alicja Dudek, Justyna Tabiś, Piotr Major, Magdalena Pisarska & Michał Pędziwiatr

  2. Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland

    Piotr Małczak, Michał Wysocki, Piotr Major, Magdalena Pisarska & Michał Pędziwiatr

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  1. Piotr Małczak
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  2. Michał Wysocki
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  3. Hanna Twardowska
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  4. Alicja Dudek
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  5. Justyna Tabiś
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  6. Piotr Major
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  7. Magdalena Pisarska
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  8. Michał Pędziwiatr
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Correspondence to Piotr Małczak.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The study was approved by the local Ethics Review Committee, Agreement No. 1072.6120.225.2017.

Statement of Informed Consent

Informed consent for surgical treatment was obtained from all patients before surgery. Informed consent was obtained from all individual participants included in the study.

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Małczak, P., Wysocki, M., Twardowska, H. et al. Impact of Adherence to the ERAS® Protocol on Short-term Outcomes after Bariatric Surgery. OBES SURG 30, 1498–1505 (2020). https://doi.org/10.1007/s11695-019-04349-7

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  • DOI: https://doi.org/10.1007/s11695-019-04349-7

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