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. 2021 Apr;31(4):1612-1617.
doi: 10.1007/s11695-020-05168-x. Epub 2021 Jan 19.

Impact of Enhanced Recovery After Bariatric Surgery (ERABS) Protocol in Reducing Length of Stay and Hospitalization Costs: the Experience of a Philanthropic Hospital in Brazil

Marcos Paulo Gouveia de Oliveira  1 , Gustavo Fernandes  2 , Juliana Fernandes Andrade  2 , Danilo Pereira Barbosa  3 , Pamela França Silva  4 , Ana Carolina Franceschilli Bossi  4 , Ana Beatriz Monteiro Correa da Costa E Silva  4
Affiliations

Impact of Enhanced Recovery After Bariatric Surgery (ERABS) Protocol in Reducing Length of Stay and Hospitalization Costs: the Experience of a Philanthropic Hospital in Brazil

Marcos Paulo Gouveia de Oliveira et al. Obes Surg. 2021 Apr.

Abstract

Overview: The global prevalence of obesity and increase in bariatric surgeries are burdening the healthcare system. Enhanced recovery postoperative protocols are associated with a reduction in hospitalization costs and length of stay (LOS) and may be an alternative to reduce public health expenses.

Objective: To assess the impact of implementing a customized Enhanced Recovery After Bariatric Surgery (ERABS) protocol on hospitalization costs (HC), LOS, and complication rates.

Setting: Santa Marcelina Hospital, São Paulo, Brazil.

Methods: A retrospective electronic health record analysis of patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy and who were cared for within a clinical pathway (CP) protocol (Jan. 2016-Aug. 2018) or after implementation of an ERABS protocol (Aug. 2018-Jun. 2019). The LOS, HC, and complication, readmission, and reoperation rates were compared between the two groups.

Results: Eighty-two patients were included in the study (CP, 56, 87.5% women; ERABS, 26, 92.3% women). Hospital LOS and total HC decreased significantly by 32.5% and 15.2%, respectively (both, p < 0.05), after implementation of ERABS. There were no significant differences in 30-day readmission, complication, or reoperation rates.

Conclusion: The implementation of a standardized enhanced recovery program resulted in reduced LOS and HC without an increase in perioperative morbidity. The ERABS protocol is cost-effective and can help ease the healthcare burden.

Keywords: Bariatric surgery; Clinical pathway; ERABS; ERAS; Fast-track; Obesity; Roux-en-Y gastric bypass; Sleeve gastrectomy.

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