There is paucity of data on Enhanced Recovery
After Bariatric Surgery (ERABS) protocols. This feasibility
study reports outcomes of this protocol utilized within a
tertiary-referral bariatric centre. Data on consecutive primary
procedures (laparoscopic gastric bypasses, sleeve gastrectomies
and gastric bands) performed over 9 months within an ERABS
protocol were prospectively recorded. Interventions utilized
included shortened preoperative fasts, intra-operative humidification,
early mobilization and feeding, avoidance of fluid overload,
incentive spirometry, use of prokinetics and laxatives.
Data collected included demographics, co-morbidities, morbidity,
mortality, length of stay (LOS) and re-admissions. A total of
226 procedures (age [mean ± SD], 45±11 years, median [interquartile
range] BMI 44.9 [41.0–49.0] kg/m2
) were undertaken:
150 (66 %) bypasses, 47 (21 %) sleeves and 29 (13 %)
bands. Hypertension, diabetes mellitus, sleep apnea and limited
mobility were present in 40 %, 34 %, 24 % and 9 % of patients,
respectively. No anastomotic or staple line leaks/bleeds were
encountered. Ten (4.4 %) patients developed postoperative
morbidity (mainly respiratory complications). One death
occurred from massive pulmonary embolus in a high-risk patient
(despite insertion of preoperative-IVC filter). Respective
mean ± SD LOS for bypasses, sleeves and bands were 1.88±
1.12, 2.30±1.69 and 0.69±0.81 days. Successful discharge on
the first postoperative day was achieved in 37 % and 28 % of
bypasses and sleeves, respectively. Day-case gastric bands were
performed in 48 %. Thirty-day hospital re-admission occurred
in six (2.7 %) patients. Applying an ERABS protocol was
feasible, safe, associated with low morbidity, acceptable LOS
and low 30-day re-admission rates. The presence of multiple
medical co-morbidities should not preclude use of an ERABS
protocol within bariatric patients.