Does ERAS impact outcomes of laparoscopic sleeve gastrectomy in adolescents?

Sule Yalcin; Stephanie M Walsh; Janet Figueroa; Kurt F Heiss; Mark L Wulkan

doi:10.1016/j.soard.2020.07.016

Does ERAS impact outcomes of laparoscopic sleeve gastrectomy in adolescents?

Surg Obes Relat Dis. 2020 Dec;16(12):1920-1926. doi: 10.1016/j.soard.2020.07.016. Epub 2020 Jul 23.

Authors

Sule Yalcin¹, Stephanie M Walsh², Janet Figueroa³, Kurt F Heiss¹, Mark L Wulkan⁴

Affiliations

¹ Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
² Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
³ Biostatistics Core, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
⁴ Department of Surgery, Akron Children's Hospital, Akron, Ohio. Electronic address: mwulkan@akronchildresn.org.

PMID: 32847759
DOI: 10.1016/j.soard.2020.07.016

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols have been successfully implemented in several surgical fields; however, the application of ERAS in the pediatric population is still limited.

Objectives: The aim was to determine if implementation of an ERAS protocol can improve outcomes of laparoscopic sleeve gastrectomy (LSG) in adolescents.

Setting: University Hospital, United States.

Methods: A retrospective analysis of 112 adolescent patients who underwent LSG from February 2011 to July 2019 was conducted. An ERAS protocol was instituted in June 2016. Conventional care patients (n = 51) were compared with ERAS patients (n = 61). Comparisons were made using Χ² tests or Fisher's exact for categoric data and Wilcoxon-rank sum tests for continuous data. Multiple linear regression was used to adjust length of stay for patient characteristics.

Results: The 2 cohorts were similar in age, sex, race, number of co-morbidities, and preoperative body mass index. The volume of intraoperative fluid, intraoperative and postoperative opioids were significantly reduced in the ERAS group (P < .0001). The number of ERAS elements received per patient increased from a median of 9 to 15 (P < .0001). ERAS group had more discharges on postoperative day 1 (48% versus 6 %, respectively). Length of stay was significantly lower in the ERAS group (2.34 versus 2.04 median d, respectively). Difference was still significant after adjusting for age, sex, race/ethnicity, payor status, American Society of Anesthesiologists score, preoperative body mass index, and the duration of surgery (P < .0001). There were no differences in postoperative complications and 30-day readmissions.

Conclusions: An LSG ERAS protocol is associated with significant reduction in perioperative opioid use and length of stay with no increase in complications or readmission rates.

Keywords: Adolescent bariatric surgery; ERAS; Enhanced recovery after surgery; Laparoscopic sleeve gastrectomy.

MeSH terms

Adolescent
Child
Enhanced Recovery After Surgery*
Gastrectomy
Humans
Laparoscopy*
Length of Stay
Postoperative Complications
Retrospective Studies