Observational Study

. 2022 Apr;32(4):1289-1299.

doi: 10.1007/s11695-022-05949-6. Epub 2022 Feb 10.

Higher Adherence to ERAS Society® Recommendations is Associated with Shorter Hospital Stay Without an Increase in Postoperative Complications or Readmissions in Bariatric Surgery: the Association Between Use of Enhanced Recovery After Surgery Protocols and Postoperative Complications after Bariatric Surgery (POWER 3) Multicenter Observational Study

Javier Ripollés-Melchor^{1

2}, Raquel Sánchez-Santos^{3

4}, Ane Abad-Motos^{5

6}, Ana M Gimeno-Moro⁷, Yolanda Díez-Remesal^{2

8}, Patricia Jove-Alborés³, Pablo Aragó-Chofre⁹, Sergio Ortiz-Sebastian¹⁰, Rubén Sánchez-Martín¹¹, José M Ramírez-Rodríguez^{2

12

13}, Ramón Trullenque-Juan¹⁴, Víctor Valentí-Azcárate^{15

16}, Álvaro Ramiro-Ruiz^{2

17}, Olga C Correa-Chacón¹⁸, Astrid Batalla¹⁹, Cassandra Gimeno-Grauwinkel²⁰, Josep Martí Sanahuja-Blasco²¹, Francisco M González-Valverde²², Patricia Galán-Menéndez²³, Miren J Díez-Zapirain²⁴, Ramón Vilallonga²⁵, Andrés Zorrilla-Vaca^{26

27}, Ana M Pascual-Bellosta²⁸, Javier Martínez-Ubieto²⁸, Teresa Carrascosa-Mirón²⁹, Alicia Ruiz-Escobar^{1

2}, Ester Martín-García-Almenta³⁰, Alejandro Suárez-de-la-Rica^{2

24}, Marc Bausili³¹, Ángela Palacios-Cordoba³², María M Olvera-García³², Julio A Meza-Vega³³, Andrés Sánchez-Pernaute^{4

30}, Alfredo Abad-Gurumeta^{1

2}, Carlos Ferrando-Ortola^{2

21

34}, Beatriz Martín-Vaquerizo³⁵, José R Torres-Alfonso³⁶, Sandra Aguado-Sánchez³⁷, Fátima Sánchez-Cabezudo-Noguera³⁸, José A García-Erce³⁹, César Aldecoa^{2

40}; POWER 3 Study Investigators Group

Affiliations

¹ Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain.
² Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.
³ Department of General Surgery, University Hospital of Vigo, Galicia Sur Research Institute (IISGS), Vigo, Spain.
⁴ Spanish Society of Obesity Surgery (SECO), San Juan de Alicante, Spain.
⁵ Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain. aneabad@hotmail.com.
⁶ Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain. aneabad@hotmail.com.
⁷ Department of Anesthesia and Perioperative Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Spain.
⁸ Department of Anesthesia and Perioperative Medicine, Ramón y Cajal University Hospital, Madrid, Spain.
⁹ Department of General Surgery, Hospital Universitario de Manises, Manises, Spain.
¹⁰ Department of General Surgery, Alicante University Hospital, Alicante, Spain.
¹¹ Department of Anesthesia and Perioperative Medicine, Clínico San Carlos University Hospital, Madrid, Spain.
¹² Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain.
¹³ Universidad de Zaragoza, Zaragoza, Spain.
¹⁴ Department of General Surgery, Doctor Peset University Hospital, Valencia, Spain.
¹⁵ Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain.
¹⁶ CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain.
¹⁷ Department of Anesthesia and Perioperative Medicine, 12 de Octubre University Hospital, Madrid, Spain.
¹⁸ Department of Anesthesia and Perioperative Medicine, Santa Lucía Hospital, Cartagena, Spain.
¹⁹ Department of Anesthesiology and Perioperative Medicine, Sant Pau University Hospital, Barcelona, Spain.
²⁰ Department of Anesthesia and Perioperative Medicine, Mataró University Hospital, Mataró, Spain.
²¹ Department of Anesthesia and Critical Care, Hospital Clínic de Barcelona, Barcelona, Spain.
²² Department of General Surgery, Reina Sofía University Hospital, Murcia, Spain.
²³ Department of Anesthesia and Perioperative Medicine, Vall d´Hebrón University Hospital, Barcelona, Spain.
²⁴ Department of Anesthesia and Perioperative Medicine, Marqués de Valdecilla University Hospital, Santander, Spain.
²⁵ Department of General Surgery, Bariatric surgery Department, Vall d´Hebrón University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
²⁶ Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
²⁷ Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²⁸ Department of Anesthesiology and Perioperative Medicine, Miquel Servet University Hospital, Zaragoza, Spain.
²⁹ Department of General Surgery, Getafe University Hospital, Getafe, Spain.
³⁰ Department of General Surgery, Clínico San Carlos University Hospital, Madrid, Spain.
³¹ Department of Anesthesia and Perioperative Medicine, Clínica Diagonal, Esplugues de Llobregat, Spain.
³² Department of Anesthesia and Perioperative Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain.
³³ Department of Anesthesia and Perioperative Medicine, Hospital de Barcelona, Barcelona, Spain.
³⁴ CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
³⁵ Department of Anesthesia and Perioperative Medicine, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain.
³⁶ Department of General Surgery. Fundación Jiménez-Díaz, Madrid, Spain.
³⁷ Department of Anesthesia and Perioperative Medicine, Hospital del Mar, Barcelona, Spain.
³⁸ Department of General Surgery, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Spain.
³⁹ Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
⁴⁰ Department of Anesthesia and Perioperative Medicine, Hospital Universitario Río Hortega, Valladolid, Spain.

PMID: 35143011
DOI: 10.1007/s11695-022-05949-6

Observational Study

Higher Adherence to ERAS Society® Recommendations is Associated with Shorter Hospital Stay Without an Increase in Postoperative Complications or Readmissions in Bariatric Surgery: the Association Between Use of Enhanced Recovery After Surgery Protocols and Postoperative Complications after Bariatric Surgery (POWER 3) Multicenter Observational Study

Javier Ripollés-Melchor et al. Obes Surg. 2022 Apr.

. 2022 Apr;32(4):1289-1299.

doi: 10.1007/s11695-022-05949-6. Epub 2022 Feb 10.

Authors

Affiliations

¹ Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain.
² Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.
³ Department of General Surgery, University Hospital of Vigo, Galicia Sur Research Institute (IISGS), Vigo, Spain.
⁴ Spanish Society of Obesity Surgery (SECO), San Juan de Alicante, Spain.
⁵ Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain. aneabad@hotmail.com.
⁶ Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain. aneabad@hotmail.com.
⁷ Department of Anesthesia and Perioperative Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Spain.
⁸ Department of Anesthesia and Perioperative Medicine, Ramón y Cajal University Hospital, Madrid, Spain.
⁹ Department of General Surgery, Hospital Universitario de Manises, Manises, Spain.
¹⁰ Department of General Surgery, Alicante University Hospital, Alicante, Spain.
¹¹ Department of Anesthesia and Perioperative Medicine, Clínico San Carlos University Hospital, Madrid, Spain.
¹² Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain.
¹³ Universidad de Zaragoza, Zaragoza, Spain.
¹⁴ Department of General Surgery, Doctor Peset University Hospital, Valencia, Spain.
¹⁵ Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain.
¹⁶ CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain.
¹⁷ Department of Anesthesia and Perioperative Medicine, 12 de Octubre University Hospital, Madrid, Spain.
¹⁸ Department of Anesthesia and Perioperative Medicine, Santa Lucía Hospital, Cartagena, Spain.
¹⁹ Department of Anesthesiology and Perioperative Medicine, Sant Pau University Hospital, Barcelona, Spain.
²⁰ Department of Anesthesia and Perioperative Medicine, Mataró University Hospital, Mataró, Spain.
²¹ Department of Anesthesia and Critical Care, Hospital Clínic de Barcelona, Barcelona, Spain.
²² Department of General Surgery, Reina Sofía University Hospital, Murcia, Spain.
²³ Department of Anesthesia and Perioperative Medicine, Vall d´Hebrón University Hospital, Barcelona, Spain.
²⁴ Department of Anesthesia and Perioperative Medicine, Marqués de Valdecilla University Hospital, Santander, Spain.
²⁵ Department of General Surgery, Bariatric surgery Department, Vall d´Hebrón University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
²⁶ Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
²⁷ Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²⁸ Department of Anesthesiology and Perioperative Medicine, Miquel Servet University Hospital, Zaragoza, Spain.
²⁹ Department of General Surgery, Getafe University Hospital, Getafe, Spain.
³⁰ Department of General Surgery, Clínico San Carlos University Hospital, Madrid, Spain.
³¹ Department of Anesthesia and Perioperative Medicine, Clínica Diagonal, Esplugues de Llobregat, Spain.
³² Department of Anesthesia and Perioperative Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain.
³³ Department of Anesthesia and Perioperative Medicine, Hospital de Barcelona, Barcelona, Spain.
³⁴ CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
³⁵ Department of Anesthesia and Perioperative Medicine, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain.
³⁶ Department of General Surgery. Fundación Jiménez-Díaz, Madrid, Spain.
³⁷ Department of Anesthesia and Perioperative Medicine, Hospital del Mar, Barcelona, Spain.
³⁸ Department of General Surgery, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Spain.
³⁹ Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
⁴⁰ Department of Anesthesia and Perioperative Medicine, Hospital Universitario Río Hortega, Valladolid, Spain.

PMID: 35143011
DOI: 10.1007/s11695-022-05949-6

Abstract

Purpose: The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements on patient outcomes following elective bariatric surgery.

Materials and methods: Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences RESULTS: We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73-1.79; P = .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 0.85; 95% CI, 0.62-1.17; P = .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 1.54; 95% CI, 1.09-2.17; P = .015), while there were no differences in the other outcomes CONCLUSIONS: Higher adherence to ERAS Society® recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions.

Trial registration: ClinicalTrials.gov Identifier: NCT03864861.

Keywords: Bariatric surgery; Enhanced recovery; Perioperative care.

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