Abstract Background Length of stay (LOS) is a key quality metric in bariatric surgery. Although Enhanced Recovery After Surgery (ERAS) protocols have been increasingly adopted in bariatric surgery and endorsed by ASMBS guidelines, evidence is still weak on this topic. Shorter LOS can lead to better outcomes, lower costs, and improved hospital efficiency. Our goal was to reduce LOS in our practice by making targeted changes to perioperative care practices. Methods This was a retrospective cohort single center study performed in an urban public city hospital, in which we analyzed the outcomes of a new perioperative protocol. During the first half of 2024, a standard protocol was followed, which included resuming diet in post operative day(POD) 1, multimodal pain control including opioids and antinausea medication. Then, in the second half, a comprehensive ERAS protocol was implemented. This included non-narcotic pain control, early mobilization, transverse abdominis plane (TAP) blocks, standardized anti-nausea strategies, and a strong educational component to encourage early diet progression starting bariatric stage 1 diet on POD 0 and early ambulation. Primary outcomes included LOS, and secondary outcomes included complications, emergency department (ED) visits and readmissions within 30 days and after 30 days. Results A total of 215 patients were analyzed, 112 in the first group and 103 in the second group. The proportion of patients discharged on postoperative day 1 increased from 31.3% to 71.8% after implementation of the protocol (P 0.00001). Median LOS decreased from 1.73 days (T1) to 1.31 days (T2) (P 0.001). Complications rates were similar (5.4% versus 6.8%, P = 0.66) between both groups. These included bleeding, dysphagia and PO intolerance. ED visits within 30 days (12.5% versus 10.7%, P = 0.68) and after 30 days (16.1% versus 10.7%, P = 0.25) were similar between groups. Readmissions within 30 days (0% versus 1.9%, P = 0.14) and after 30 days (1.8% versus 1.9%, P = 0.93) were low and comparable in both groups. Conclusion In conclusion, the new ERAS protocol successfully reduced LOS while maintaining low complication and readmission rates. The most impactful changes were in pain management, mobilization, standardized anti-nausea protocol and resuming Bariatric stage 1 diet in POD0 instead of POD1. This model can be applied in similar (underserved) populations to enhance surgical care outcomes.
Serra et al. (Thu,) studied this question.