Background

Enhanced recovery after surgery (ERAS) aligns the practice of anesthesia with the care given by the surgical team before, during, and after surgery. In bariatric surgery, randomized clinical trials (RCT) on ERAS are few. We report the results of an RCT testing an ERAS protocol incorporating a novel multidrug strategy in patients undergoing laparoscopic sleeve gastrectomy (LSG).

Methods

132 patients undergoing LSG between March 2018 and January 2019 were randomized to either standard of care (SOC; N=65) or ERAS (N=67). Ten patients were excluded due to protocol violation. ERAS included a pre- and post-surgical medication regimen designed to reduce postoperative nausea, vomiting and opioid use. Groups were compared on time from arrival to the post-anesthesia care unit (PACU) until ready for discharge (RFD; measured on an objective 5-point scale including vital signs, liquid intake, nausea and vomiting score, pain score and ambulation). Outcomes included post-operative use of opioids and rescue anti-emetics and 30-day unanticipated LSG-related events.

Results

Final analysis included 57 patients in SOC and 65 in ERAS (Table 1). No significant differences were observed on demographics or comorbidities present at time of LSG. Times from PACU to RFD5 and from PACU to discharge were significantly shorter for ERAS as was hospital length of stay. Opioid use was significantly lower for ERAS with no significant differences in postoperative rescue anti-emetics or 30-day events.

Conclusions

After LSG, ERAS patients achieved RFD status faster and used opioids less frequently and in lower amounts without a significant increase in 30-day events.