Background

Enhanced recovery after surgery protocols (ERAS) are standardized perioperative programs designed to improve postoperative outcomes. This study evaluated the effect of ERAS implementation in patients undergoing bariatric surgery. This single-center retrospective review compared outcomes between a pre-ERAS cohort (January 2016-July 2019) and a post-ERAS cohort (March 2021-July 2023) of adult patients undergoing laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRYGB) for weight loss. Our ERAS included preoperative interventions (expectation management, antiemetics, multimodal pain medication), intraoperative interventions (dexmedetomidine infusion, laparoscopic guided nerve block, dexamethasone administration), and postoperative interventions (immediate postoperative diet, multimodal pain medication, early ambulation). Primary endpoints were hospital length of stay (LOS) and total morphine milligram equivalents (MME) utilized in the perioperative period. The study included 389 and 551 patients in the pre-ERAS and post-ERAS cohort, respectively. Demographics between the two groups were similar, with pre-ERAS and post-ERAS average age 46 vs 47 years, average Body Mass Index 46 vs 46, and 81% vs 83% female, respectively. LSG was slightly more prevalent post-ERAS (52% vs 59%, p=0.039). The post-ERAS cohort had shorter LOS (2.4 vs 1.5 days, p<.001), lower total administered perioperative MME (105 vs 50, p<0.001), and lower average pain scores (4.5 vs 3.4, p<0.001). Fewer patients were discharged with an opioid prescription in the post-ERAS cohort (91% vs 36%, p<0.001). There was no significant difference in 30-day readmission or mortality rates between groups. ERAS implementation resulted in decreased total perioperative opioid use and hospital LOS in bariatric surgery patients without increasing 30-day mortality or readmission.