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. 2018 Apr;226(4):605-613.
doi: 10.1016/j.jamcollsurg.2017.12.028. Epub 2018 Jan 5.

Barriers to Enhanced Recovery After Surgery After Laparoscopic Sleeve Gastrectomy

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Barriers to Enhanced Recovery After Surgery After Laparoscopic Sleeve Gastrectomy

Arinbjorn Jonsson et al. J Am Coll Surg. .

Abstract

Background: Enhanced Recovery after Surgery (ERAS) protocols lead to expedited discharges and decreased cost. Bariatric centers have adopted such programs for safely discharging patients after sleeve gastrectomy (LSG) on the first postoperative day (POD1). Despite pathways, some bariatric patients cannot be discharged on POD1.

Study design: We performed a retrospective review of patients undergoing LSG, from 2013 through 2016, in a center of excellence, using a standardized enhanced recovery pathway. Patient variables and perioperative factors were analyzed, including multivariate regressions, for predictors of early discharge.

Results: There were 573 patients who underwent LSG (83% female, mean age of 46.3 ± 11.7 years, and BMI of 46.0 ± 6.6 kg/m2). Mean hospital stay was 1.7 days ± 1.0 SD. Early discharge occurred in 38.2% of patients. Independently, early operating room start times and treated obstructive sleep apnea were associated with earlier discharge (p < 0.05). In contrast, preoperative opioid use, history of psychiatric illness, chronic kidney disease, and revision cases delayed discharge (p < 0.05). Age, sex, American Society of Anesthesiologists (ASA) class, diabetes, congestive heart failure, hypertension, distance to home, and insurance status were not significant. On regression modeling, early operating room start time and treated obstructive sleep apnea (OSA) reduced length of stay (LOS) (p < 0.05), while creatinine >1.5 mg/dL, ejection fraction < 50%, and increased case duration increased LOS (p < 0.05). Fifteen patients were readmitted within 30 days (2.6%).

Conclusions: Several clinical and operative factors affect early discharge after LSG. Knowing factors that enhance the success of ERAS as well as the causes and corrections for failed implementation allow teams to optimally direct care pathway resources.

Comment in

  • Discussion.
    J Am Coll Surg. 2018 Apr;226(4):613-614. doi: 10.1016/j.jamcollsurg.2018.01.019. J Am Coll Surg. 2018. PMID: 29576162 No abstract available.

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