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Meta-Analysis
. 2024 Mar;34(3):778-789.
doi: 10.1007/s11695-024-07072-0. Epub 2024 Jan 26.

Evaluating the Impact of Enhanced Recovery After Surgery Protocols on Surgical Outcomes Following Bariatric Surgery-A Systematic Review and Meta-analysis of Randomised Clinical Trials

Matthew G Davey  1   2 , Noel E Donlon  3   4 , Naomi M Fearon  5 , Helen M Heneghan  5 , John B Conneely  4
Affiliations
Meta-Analysis

Evaluating the Impact of Enhanced Recovery After Surgery Protocols on Surgical Outcomes Following Bariatric Surgery-A Systematic Review and Meta-analysis of Randomised Clinical Trials

Matthew G Davey et al. Obes Surg. 2024 Mar.

Abstract

Background: Enhanced recovery after surgery (ERAS) programmes are evidence-based care improvement processes for surgical patients, which are designed to decrease the impact the anticipated negative physiological cascades following surgery.

Aim: To perform a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the impact of ERAS protocols on outcomes following bariatric surgery compared to standard care (SC).

Methods: A systematic review was performed in accordance with PRISMA guidelines. Meta-analysis was performed using Review Manager version 5.4 RESULTS: Six RCTs including 740 patients were included. The mean age was 40.2 years, and mean body mass index was 44.1 kg/m2. Overall, 54.1% underwent Roux-en-Y gastric bypass surgery (400/740) and 45.9% sleeve gastrectomy (340/700). Overall, patients randomised to ERAS programmes had a significant reduction in nausea and vomiting (odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19-0.95, P = 0.040), intraoperative time (mean difference (MD): 5.40, 95% CI: 3.05-7.77, P < 0.001), time to mobilisation (MD: - 7.78, 95% CI: - 5.46 to - 2.10, P < 0.001), intensive care unit stay (ICUS) (MD: 0.70, 95% CI: 0.13-1.27, P = 0.020), total hospital stay (THS) (MD: - 0.42, 95% CI: - 0.69 to - 0.16, P = 0.002), and functional hospital stay (FHS) (MD: - 0.60, 95% CI: - 0.98 to - 0.22, P = 0.002) compared to those who received SC.

Conclusion: ERAS programmes reduce postoperative nausea and vomiting, intraoperative time, time to mobilisation, ICUS, THS, and FHS compared to those who received SC. Accordingly, ERAS should be implemented, where feasible, for patients indicated to undergo bariatric surgery. Trial registration International Prospective Register of Systematic Reviews (PROSPERO - CRD42023434492.

Keywords: Bariatric surgery; ERAS; Enhanced recovery after surgery; Patient outcomes.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart demonstrating the systematic search process
Fig. 2
Fig. 2
Forest plots for A overall complications, B major complications, C leaks, D bleeding, and E nausea and vomiting for comparison of enhanced recovery after surgery and standard care protocols following bariatric surgery
Fig. 3
Fig. 3
Forest plots for A reoperation rates, B intraoperative time, C postoperative pain using the visual analogue scale, D time to mobilisation, and E intensive care unit stay time for comparison of enhanced recovery after surgery and standard care protocols following bariatric surgery
Fig. 4
Fig. 4
Forest plots for A total hospital stay, B functional hospital stay, C 30-day readmission rates, and D hospitalisation costs for comparison of enhanced recovery after surgery and standard care protocols following bariatric surgery
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