Scientific publications
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-Moro 7 , Yolanda Díez-Remesal 2 8 , Patricia Jove-Alborés 3 , Pablo Aragó-Chofre 9 , Sergio Ortiz-Sebastian 10 , Rubén Sánchez-Martín 11 , José M Ramírez-Rodríguez 2 12 13 , Ramón Trullenque-Juan 14 , Víctor Valentí-Azcárate 15 16 , Álvaro Ramiro-Ruiz 2 17 , Olga C Correa-Chacón 18 , Astrid Batalla 19 , Cassandra Gimeno-Grauwinkel 20 , Josep Martí Sanahuja-Blasco 21 , Francisco M González-Valverde 22 , Patricia Galán-Menéndez 23 , Miren J Díez-Zapirain 24 , Ramón Vilallonga 25 , Andrés Zorrilla-Vaca 26 27 , Ana M Pascual-Bellosta 28 , Javier Martínez-Ubieto 28 , Teresa Carrascosa-Mirón 29 , Alicia Ruiz-Escobar 1 2 , Ester Martín-García-Almenta 30 , Alejandro Suárez-de-la-Rica 2 24 , Marc Bausili 31 , Ángela Palacios-Cordoba 32 , María M Olvera-García 32 , Julio A Meza-Vega 33 , Andrés Sánchez-Pernaute 4 30 , Alfredo Abad-Gurumeta 1 2 , Carlos Ferrando-Ortola 2 21 34 , Beatriz Martín-Vaquerizo 35 , José R Torres-Alfonso 36 , Sandra Aguado-Sánchez 37 , Fátima Sánchez-Cabezudo-Noguera 38 , José A García-Erce 39 , César Aldecoa 2 40 , POWER 3 Study Investigators Group
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.
CITATION Obes Surg. 2022 Apr;32(4):1289-1299. doi: 10.1007/s11695-022-05949-6. Epub 2022 Feb 10
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