Enhanced Recovery After Surgery (ERAS) is a paradigm shift in preoperative, perioperative, and postoperative care that is taking the nation by storm. ERAS refers to patient-centered, evidence-based, multidisciplinary team developed pathways for a surgical specialty and facility to reduce the patient’s surgical stress response, optimize their physiologic function, and facilitate recovery. In 2017, roughly 228,000 bariatric surgeries were performed in the United States with 59% of those encompassing sleeve gastrectomies.
Beginning in January 2018 our center implemented an ERAS Bariatric Surgery program that included preoperative, perioperative, and postoperative interventions. We retrospectively reviewed all Sleeve Gastrectomy discharges between January 2016 and June 2019 in order to evaluate changes in length of stay, direct cost, and 30 day re-admission rates between the pre and post program implementation. Differences in outcomes between the pre and post periods were assessed using the Wicoxon rank sum and Chi squared test as appropriate.
A total of 1487 sleeve gastrectomies were identified with 793 pre implementation and 694 post implementation. The mean length of stay (SD) in the pre and post periods were 1.58 (0.97) and 1.36 (0.62) days, respectively (p<0.001), with a significant increase in percentage of those staying 1 day (70.9%) and significant decreases in those staying >2 days. Average direct costs decreased by $823 per case in the post period (p<0.001). There was no significant difference in 30 day readmission rate between the pre and post periods (31% vs 20%, p=0.346).
The use of our Bariatric ERAS program has resulted in rapid surgical recovery, shorter length of stay, and decreased cost per case. With such evident data to support the use of ERAS programs, it should be strongly encouraged throughout our hospital system within the field of bariatric surgery and beyond.