Less pain and earlier discharge after implementation of a multidisciplinary enhanced recovery after surgery (ERAS) protocol for laparoscopic sleeve gastrectomy
Background Laparoscopic sleeve gastrectomy (LSG) may be complicated by postoperative pain, nausea, and vomiting, with consequent increases in length of stay (LOS), decreased patient satisfaction, and higher costs. While enhanced recovery after surgery (ERAS) protocols have been in circulation for ma...
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| Veröffentlicht in: | Surgical endoscopy 2020-12, Vol.34 (12), p.5574-5582 |
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| creator | Jones, Daniel B. Abu-Nuwar, Mohamad Rassoul A. Ku, Cindy M. Berk, Leigh-Ann S. Trainor, Linda S. Jones, Stephanie B. |
| description | Background
Laparoscopic sleeve gastrectomy (LSG) may be complicated by postoperative pain, nausea, and vomiting, with consequent increases in length of stay (LOS), decreased patient satisfaction, and higher costs. While enhanced recovery after surgery (ERAS) protocols have been in circulation for many years, there is no standard ERAS protocol for bariatric surgery.
Methods
Data were collected prospectively and compared to a historical control. All patients undergoing LSG, ages 18 to 75, were included in the pathway; those with preoperative chronic opioid use were excluded from our results. Statistical analysis was performed using t-statistics and chi-squared test. Ninety patients undergoing LSG, performed by a single surgeon, were included in our ERAS group from November 26, 2018, to April 30, 2019, and were compared to a historical control of 570 patients who underwent LSG over the previous 5 years (pre-ERAS). Measured outcomes included discharge opioid prescriptions issued, hospital length of stay, 30-day readmissions, reoperations, morbidity, and mortality.
Results
Ten (11%) ERAS patients vs 100% of pre-ERAS patients received opioid prescriptions upon, or after, discharge (
p
|
| doi_str_mv | 10.1007/s00464-019-07358-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2339000382</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2339000382</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-61c0a354221aa543988e2af8597bd1c91bbbeedc20d0d6a9ef95d808b8278a4c3</originalsourceid><addsrcrecordid>eNp9kc1u1TAQhS0EopfCC7BAltiURcA_yY29rKoWkK6ExM_amjiT1pUTBztp1afhVZmSAhILVtbY3xzPmcPYSyneSiHad0WIel9XQtpKtLox1e0jtpO1VpVS0jxmO2G1qFRr6yP2rJRrQbyVzVN2pKXVxiqzYz8OWAqfIUwcpp4j5Bgw8z4UfwX5EjkMC9VhnCOOOC2whDTxNHDg4xqXcA-GOYYJ8h3H6Qomjz3P6NMN0s3WXVZSourk_PPplzd8zmlJPkU-pMwjzJBT8WkOnpeIeIP8EspCEksa756zJwPEgi8ezmP27eL869mH6vDp_cez00Plddss1V56AbqpyThAU2trDCoYTGPbrpfeyq7rEHuvRC_6PVgcbNMbYTqjWgO118fsZNOl4b6vWBY3kjOMESZMa3FKa0v700YR-vof9DqteaLpnKpb2Wipmz1RaqM8uSsZBzfnMNKWnBTuPj63xecoPvcrPndLTa8epNduxP5Py--8CNAbUOhpoqX-_fs_sj8B0heprA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2471531356</pqid></control><display><type>article</type><title>Less pain and earlier discharge after implementation of a multidisciplinary enhanced recovery after surgery (ERAS) protocol for laparoscopic sleeve gastrectomy</title><source>SpringerNature Journals</source><creator>Jones, Daniel B. ; Abu-Nuwar, Mohamad Rassoul A. ; Ku, Cindy M. ; Berk, Leigh-Ann S. ; Trainor, Linda S. ; Jones, Stephanie B.</creator><creatorcontrib>Jones, Daniel B. ; Abu-Nuwar, Mohamad Rassoul A. ; Ku, Cindy M. ; Berk, Leigh-Ann S. ; Trainor, Linda S. ; Jones, Stephanie B.</creatorcontrib><description>Background
Laparoscopic sleeve gastrectomy (LSG) may be complicated by postoperative pain, nausea, and vomiting, with consequent increases in length of stay (LOS), decreased patient satisfaction, and higher costs. While enhanced recovery after surgery (ERAS) protocols have been in circulation for many years, there is no standard ERAS protocol for bariatric surgery.
Methods
Data were collected prospectively and compared to a historical control. All patients undergoing LSG, ages 18 to 75, were included in the pathway; those with preoperative chronic opioid use were excluded from our results. Statistical analysis was performed using t-statistics and chi-squared test. Ninety patients undergoing LSG, performed by a single surgeon, were included in our ERAS group from November 26, 2018, to April 30, 2019, and were compared to a historical control of 570 patients who underwent LSG over the previous 5 years (pre-ERAS). Measured outcomes included discharge opioid prescriptions issued, hospital length of stay, 30-day readmissions, reoperations, morbidity, and mortality.
Results
Ten (11%) ERAS patients vs 100% of pre-ERAS patients received opioid prescriptions upon, or after, discharge (
p
< 0.001). The ERAS group LOS decreased to 1.36 days vs 2.40 days in the pre-ERAS group (
p
< 0.001). 30-day readmission rates were 0% for ERAS patients vs 3.09% for pre-ERAS patients (
p
= 0.149). 30-day reoperation rates were 0% for ERAS patients vs 0.54% for pre-ERAS patients (
p
= 1). Thirty-day morbidity rates were 3.33% (3) for ERAS patients vs 3.27% for pre-ERAS patients (
p
= 1); there was no 30-day mortality in either group.
Conclusion
ERAS for LSG results in a clinical and statistically significant reduction in postoperative opioid use and LOS, without increasing 30-day readmissions, reoperations, morbidity, or mortality.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-019-07358-w</identifier><identifier>PMID: 31938928</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Gastroenterology ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Laparoscopy ; Medicine ; Medicine & Public Health ; Morbidity ; Mortality ; Narcotics ; Patient satisfaction ; Proctology ; Recovery (Medical) ; Surgery</subject><ispartof>Surgical endoscopy, 2020-12, Vol.34 (12), p.5574-5582</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-61c0a354221aa543988e2af8597bd1c91bbbeedc20d0d6a9ef95d808b8278a4c3</citedby><cites>FETCH-LOGICAL-c375t-61c0a354221aa543988e2af8597bd1c91bbbeedc20d0d6a9ef95d808b8278a4c3</cites><orcidid>0000-0001-8342-0374</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-019-07358-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-019-07358-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31938928$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jones, Daniel B.</creatorcontrib><creatorcontrib>Abu-Nuwar, Mohamad Rassoul A.</creatorcontrib><creatorcontrib>Ku, Cindy M.</creatorcontrib><creatorcontrib>Berk, Leigh-Ann S.</creatorcontrib><creatorcontrib>Trainor, Linda S.</creatorcontrib><creatorcontrib>Jones, Stephanie B.</creatorcontrib><title>Less pain and earlier discharge after implementation of a multidisciplinary enhanced recovery after surgery (ERAS) protocol for laparoscopic sleeve gastrectomy</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Laparoscopic sleeve gastrectomy (LSG) may be complicated by postoperative pain, nausea, and vomiting, with consequent increases in length of stay (LOS), decreased patient satisfaction, and higher costs. While enhanced recovery after surgery (ERAS) protocols have been in circulation for many years, there is no standard ERAS protocol for bariatric surgery.
Methods
Data were collected prospectively and compared to a historical control. All patients undergoing LSG, ages 18 to 75, were included in the pathway; those with preoperative chronic opioid use were excluded from our results. Statistical analysis was performed using t-statistics and chi-squared test. Ninety patients undergoing LSG, performed by a single surgeon, were included in our ERAS group from November 26, 2018, to April 30, 2019, and were compared to a historical control of 570 patients who underwent LSG over the previous 5 years (pre-ERAS). Measured outcomes included discharge opioid prescriptions issued, hospital length of stay, 30-day readmissions, reoperations, morbidity, and mortality.
Results
Ten (11%) ERAS patients vs 100% of pre-ERAS patients received opioid prescriptions upon, or after, discharge (
p
< 0.001). The ERAS group LOS decreased to 1.36 days vs 2.40 days in the pre-ERAS group (
p
< 0.001). 30-day readmission rates were 0% for ERAS patients vs 3.09% for pre-ERAS patients (
p
= 0.149). 30-day reoperation rates were 0% for ERAS patients vs 0.54% for pre-ERAS patients (
p
= 1). Thirty-day morbidity rates were 3.33% (3) for ERAS patients vs 3.27% for pre-ERAS patients (
p
= 1); there was no 30-day mortality in either group.
Conclusion
ERAS for LSG results in a clinical and statistically significant reduction in postoperative opioid use and LOS, without increasing 30-day readmissions, reoperations, morbidity, or mortality.</description><subject>Abdominal Surgery</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Laparoscopy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Narcotics</subject><subject>Patient satisfaction</subject><subject>Proctology</subject><subject>Recovery (Medical)</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc1u1TAQhS0EopfCC7BAltiURcA_yY29rKoWkK6ExM_amjiT1pUTBztp1afhVZmSAhILVtbY3xzPmcPYSyneSiHad0WIel9XQtpKtLox1e0jtpO1VpVS0jxmO2G1qFRr6yP2rJRrQbyVzVN2pKXVxiqzYz8OWAqfIUwcpp4j5Bgw8z4UfwX5EjkMC9VhnCOOOC2whDTxNHDg4xqXcA-GOYYJ8h3H6Qomjz3P6NMN0s3WXVZSourk_PPplzd8zmlJPkU-pMwjzJBT8WkOnpeIeIP8EspCEksa756zJwPEgi8ezmP27eL869mH6vDp_cez00Plddss1V56AbqpyThAU2trDCoYTGPbrpfeyq7rEHuvRC_6PVgcbNMbYTqjWgO118fsZNOl4b6vWBY3kjOMESZMa3FKa0v700YR-vof9DqteaLpnKpb2Wipmz1RaqM8uSsZBzfnMNKWnBTuPj63xecoPvcrPndLTa8epNduxP5Py--8CNAbUOhpoqX-_fs_sj8B0heprA</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Jones, Daniel B.</creator><creator>Abu-Nuwar, Mohamad Rassoul A.</creator><creator>Ku, Cindy M.</creator><creator>Berk, Leigh-Ann S.</creator><creator>Trainor, Linda S.</creator><creator>Jones, Stephanie B.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8342-0374</orcidid></search><sort><creationdate>20201201</creationdate><title>Less pain and earlier discharge after implementation of a multidisciplinary enhanced recovery after surgery (ERAS) protocol for laparoscopic sleeve gastrectomy</title><author>Jones, Daniel B. ; Abu-Nuwar, Mohamad Rassoul A. ; Ku, Cindy M. ; Berk, Leigh-Ann S. ; Trainor, Linda S. ; Jones, Stephanie B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-61c0a354221aa543988e2af8597bd1c91bbbeedc20d0d6a9ef95d808b8278a4c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdominal Surgery</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Laparoscopy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Narcotics</topic><topic>Patient satisfaction</topic><topic>Proctology</topic><topic>Recovery (Medical)</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jones, Daniel B.</creatorcontrib><creatorcontrib>Abu-Nuwar, Mohamad Rassoul A.</creatorcontrib><creatorcontrib>Ku, Cindy M.</creatorcontrib><creatorcontrib>Berk, Leigh-Ann S.</creatorcontrib><creatorcontrib>Trainor, Linda S.</creatorcontrib><creatorcontrib>Jones, Stephanie B.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jones, Daniel B.</au><au>Abu-Nuwar, Mohamad Rassoul A.</au><au>Ku, Cindy M.</au><au>Berk, Leigh-Ann S.</au><au>Trainor, Linda S.</au><au>Jones, Stephanie B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Less pain and earlier discharge after implementation of a multidisciplinary enhanced recovery after surgery (ERAS) protocol for laparoscopic sleeve gastrectomy</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>34</volume><issue>12</issue><spage>5574</spage><epage>5582</epage><pages>5574-5582</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Laparoscopic sleeve gastrectomy (LSG) may be complicated by postoperative pain, nausea, and vomiting, with consequent increases in length of stay (LOS), decreased patient satisfaction, and higher costs. While enhanced recovery after surgery (ERAS) protocols have been in circulation for many years, there is no standard ERAS protocol for bariatric surgery.
Methods
Data were collected prospectively and compared to a historical control. All patients undergoing LSG, ages 18 to 75, were included in the pathway; those with preoperative chronic opioid use were excluded from our results. Statistical analysis was performed using t-statistics and chi-squared test. Ninety patients undergoing LSG, performed by a single surgeon, were included in our ERAS group from November 26, 2018, to April 30, 2019, and were compared to a historical control of 570 patients who underwent LSG over the previous 5 years (pre-ERAS). Measured outcomes included discharge opioid prescriptions issued, hospital length of stay, 30-day readmissions, reoperations, morbidity, and mortality.
Results
Ten (11%) ERAS patients vs 100% of pre-ERAS patients received opioid prescriptions upon, or after, discharge (
p
< 0.001). The ERAS group LOS decreased to 1.36 days vs 2.40 days in the pre-ERAS group (
p
< 0.001). 30-day readmission rates were 0% for ERAS patients vs 3.09% for pre-ERAS patients (
p
= 0.149). 30-day reoperation rates were 0% for ERAS patients vs 0.54% for pre-ERAS patients (
p
= 1). Thirty-day morbidity rates were 3.33% (3) for ERAS patients vs 3.27% for pre-ERAS patients (
p
= 1); there was no 30-day mortality in either group.
Conclusion
ERAS for LSG results in a clinical and statistically significant reduction in postoperative opioid use and LOS, without increasing 30-day readmissions, reoperations, morbidity, or mortality.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31938928</pmid><doi>10.1007/s00464-019-07358-w</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-8342-0374</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2020-12, Vol.34 (12), p.5574-5582 |
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| language | eng |
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| source | SpringerNature Journals |
| subjects | Abdominal Surgery Gastroenterology Gastrointestinal surgery Gynecology Hepatology Laparoscopy Medicine Medicine & Public Health Morbidity Mortality Narcotics Patient satisfaction Proctology Recovery (Medical) Surgery |
| title | Less pain and earlier discharge after implementation of a multidisciplinary enhanced recovery after surgery (ERAS) protocol for laparoscopic sleeve gastrectomy |
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