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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.pdf (1.86 MB)

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

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posted on 2024-03-19, 11:50 authored by Matthew G Davey, Noel E Donlon, Naomi M Fearon, Helen M Heneghan, John B Conneely

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.

Funding

Open Access funding provided by the IReL Consortium

History

Data Availability Statement

Data will be made available upon reasonable request from the corresponding author

Comments

The original article is available at https://link.springer.com/

Published Citation

Davey MG, Donlon NE, Fearon NM, Heneghan HM, Conneely JB. 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. Obes Surg. 2024;34(3):778-789

Publication Date

26 January 2024

PubMed ID

38273146

Publisher

Springer Nature

Version

  • Published Version (Version of Record)

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