Implementation of an enhanced recovery program for bariatric surgery.
Surg Endosc
; 34(6): 2675-2681, 2020 06.
Article
em En
| MEDLINE
| ID: mdl-31372891
ABSTRACT
INTRODUCTION:
Enhanced recovery after surgery (ERAS) programs have been successfully implemented in several surgical fields; however, there have been mixed results observed in bariatric surgery. Our institution implemented an enhanced recovery program with specific pre-, intra-, and post-operative protocols aimed at patients, nursing staff, and physicians. The aim of the study is to assess the effectiveness of the ERAS program.METHODS:
Patients who underwent bariatric surgery prior to the implementation of the enhanced recovery program in the calendar year 2015 were compared to those who had surgery after implementation in 2017. Data for our institution was drawn from the Premier Hospital Database. Poisson and quantile regressions were used to examine the association between ERAS protocol and LOS and cost, respectively. Logistic regression was used to assess the impact of ERAS on 30-day complications and readmissions.RESULTS:
277 bariatric surgical procedures were performed in the pre-ERAS group, compared to 348 procedures post-ERAS. While there was a 25.6% increase in volume, there was no statistical difference between the patient populations or the type of procedure performed between the 2 years. A decrease in length of stay was observed from 2.77 days in 2015 to 1.77 days in 2017 (p < 0.001), while median cost was also cut from $11,739.03 to $9482.18 (p < 0.001). 30-day readmission rate also decreased from 7.94% to 2.86% (p = 0.011). After controlling for other factors, ERAS protocol was associated with decreased LOS (IRR 0.65, p < 0.001), cost (- $2256.88, p < 0.001), and risk of 30-day readmission (OR 0.37, p = 0.011).CONCLUSION:
The implementation of a standardized enhanced recovery program resulted in reduced length of stay, cost, and 30-day readmissions. Total costs saved were greater than $800,000 in one calendar year. This study highlights that the value of an enhanced recovery program can be observed in bariatric surgery, benefiting both patients and hospital systems.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cirurgia Bariátrica
/
Recuperação Pós-Cirúrgica Melhorada
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
/
Sysrev_observational_studies
Aspecto:
Implementation_research
Limite:
Adult
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Female
/
Humans
/
Male
Idioma:
En
Revista:
Surg Endosc
Ano de publicação:
2020
Tipo de documento:
Article