Implementing enhanced recovery after bariatric surgery protocol: a retrospective study

J Anesth. 2016 Feb;30(1):170-3. doi: 10.1007/s00540-015-2089-6. Epub 2015 Oct 24.


While the demand for bariatric surgery is increasing, hospital capacity remains limited. The ERABS (Enhanced Recovery After Bariatric Surgery) protocol has been implemented in a number of bariatric centers. We retrospectively compared the operating room logistics and postoperative complications between pre-ERABS and ERABS periods in an academic hospital. The primary endpoint was the length of stay in hospital. The secondary endpoints were turnover times-the time required for preparing the operating room for the next case, induction time (from induction of anesthesia until a patient is ready for surgery), surgical time (duration of surgery), procedure time (duration of stay in the operating room), and the incidence of re-admissions, re-operations and complications during admission and within 30 days after surgery. Of a total of 374 patients, 228 and 146 received surgery following the pre-ERABS and ERABS protocols, respectively. The length of hospital stay was significantly shortened from 3.7 (95 % confidence interval [CI] 3.1-4.7) days to 2.1 (95 % CI 1.6-2.6) days (P < 0.001). Procedure (surgical) times were shortened by 15 (7) min and 12 (5) min for gastric bypass and gastric sleeve surgery, respectively (P < 0.001 for both), by introducing the ERABS protocol. Induction times were reduced from 15.2 (95 % CI 14.3-16.1) min to 12.5 (95 % CI 11.7-13.3) min (P < 0.001).Turnover times were shortened significantly from 38 (95 % CI 44-32) min to 11 (95 % CI 8-14) min. The incidence of re-operations, re-admissions and complications did not change.

Keywords: Bariatric surgery; Early recovery after bariatric surgery; Gastric bypass; Sleeve gastrectomy and morbid obesity.

MeSH terms

  • Adult
  • Bariatric Surgery / methods*
  • Female
  • Gastric Bypass / methods*
  • Humans
  • Incidence
  • Laparoscopy / methods
  • Length of Stay
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery*
  • Operating Rooms
  • Operative Time
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Reoperation / statistics & numerical data
  • Retrospective Studies