Impact of Enhanced Recovery After Surgery (ERAS) Combined with Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) Protocol on Patient Outcomes, Length of Stay and Opioid Prescription After Bariatric Surgery
Background Evidence shows that 14.2% of opioid-naive patients have long-term opioid dependence after bariatric surgery. Enhanced recovery after surgery (ERAS) protocols are widely used in bariatric surgery, while bariatric surgery targeting opioid prescriptions (BSTOP) protocols were recently introd...
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| Veröffentlicht in: | Obesity surgery 2023-10, Vol.33 (10), p.3206-3211 |
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| creator | Silverstein, Jeffrey Sohail, Amir H. Silva-Pacheco, Tulio B. Khayat, Adam Amodu, Leo Cherasard, Patricia Levine, Jun Goparaju, Anirudha Kella, Venkata Shahidul, Islam Petrone, Patrizio Brathwaite, Collin E. M. |
| description | Background
Evidence shows that 14.2% of opioid-naive patients have long-term opioid dependence after bariatric surgery. Enhanced recovery after surgery (ERAS) protocols are widely used in bariatric surgery, while bariatric surgery targeting opioid prescriptions (BSTOP) protocols were recently introduced. We will investigate the combined impact of ERAS and BSTOP protocols after bariatric surgery.
Methods
We conducted a retrospective review for patients who underwent either a sleeve gastrectomy or Roux-en-Y gastric bypass at a tertiary care center. Pre-intervention and post-intervention data were compared. Primary outcomes were length of stay (LOS), 30-day readmission, 30-day complications, and discharge on opioids. Multivariate Poisson regression with robust standard error was used to analyze LOS.
Results
There was no significant difference in 30-day emergency room visits (3.3% vs. 4.0%;
p
value = 0.631), 30-day readmission (4.4% vs. 5.4%;
p
value = 0.577) or 30-day complication rate (4.2% vs. 6.4%;
p
value = 0.199). LOS was significantly lower in the post-intervention group; mean (interquartile range) 2 (1–2) days vs. 1 (1–2) day,
p
value |
| doi_str_mv | 10.1007/s11695-023-06794-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2860406763</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2866960989</sourcerecordid><originalsourceid>FETCH-LOGICAL-c352t-a8a34b90ee69fb6a564e76eea70dfe4b848901fed576a95d3fb78cb388d736333</originalsourceid><addsrcrecordid>eNp9kdFu0zAUhiMEEmXwAlxZ4maTFnDsxLEvu6obkyq1Wsu15TgnnafGDrYD69vwLDzEngeXDk0aiKsjW9_59R99Wfa-wB8LjOtPoSiYqHJMaI5ZLcr8_kU2KWrMc1wS_jKbYMFwzgWhr7M3IdxhTApGyCR7uO4HpSNyHZrbW2U1tOgGtPsGfo-mXQSP1qPfptfPH6fzm-n6DM1c3xibuO8m3qIL5Y2K3ug_HNqoNKOxW7QcjDMtWnkI2pshGmdDirlYb5ars_TtotNuh5xFKxUN2IiWY9Suh3COFmC3KT71Wke1R8q2_4p7rPhXibfZq07tArx7nCfZl8v5ZvY5XyyvrmfTRa5pRWKuuKJlIzAAE13DVMVKqBmAqnHbQdnwkgtcdNBWNVOiamnX1Fw3lPO2poxSepKdHnMH776OEKLsTdCw2ykLbgyScIbLZIQd0A_P0Ds3epvaHSiW_AguEkWOlPYuBA-dHLzpld_LAsuDanlULZNq-Vu1vE9L9LgUEmzT_U_R_9n6Ba30sas</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2866960989</pqid></control><display><type>article</type><title>Impact of Enhanced Recovery After Surgery (ERAS) Combined with Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) Protocol on Patient Outcomes, Length of Stay and Opioid Prescription After Bariatric Surgery</title><source>SpringerLink Journals</source><creator>Silverstein, Jeffrey ; Sohail, Amir H. ; Silva-Pacheco, Tulio B. ; Khayat, Adam ; Amodu, Leo ; Cherasard, Patricia ; Levine, Jun ; Goparaju, Anirudha ; Kella, Venkata ; Shahidul, Islam ; Petrone, Patrizio ; Brathwaite, Collin E. M.</creator><creatorcontrib>Silverstein, Jeffrey ; Sohail, Amir H. ; Silva-Pacheco, Tulio B. ; Khayat, Adam ; Amodu, Leo ; Cherasard, Patricia ; Levine, Jun ; Goparaju, Anirudha ; Kella, Venkata ; Shahidul, Islam ; Petrone, Patrizio ; Brathwaite, Collin E. M.</creatorcontrib><description>Background
Evidence shows that 14.2% of opioid-naive patients have long-term opioid dependence after bariatric surgery. Enhanced recovery after surgery (ERAS) protocols are widely used in bariatric surgery, while bariatric surgery targeting opioid prescriptions (BSTOP) protocols were recently introduced. We will investigate the combined impact of ERAS and BSTOP protocols after bariatric surgery.
Methods
We conducted a retrospective review for patients who underwent either a sleeve gastrectomy or Roux-en-Y gastric bypass at a tertiary care center. Pre-intervention and post-intervention data were compared. Primary outcomes were length of stay (LOS), 30-day readmission, 30-day complications, and discharge on opioids. Multivariate Poisson regression with robust standard error was used to analyze LOS.
Results
There was no significant difference in 30-day emergency room visits (3.3% vs. 4.0%;
p
value = 0.631), 30-day readmission (4.4% vs. 5.4%;
p
value = 0.577) or 30-day complication rate (4.2% vs. 6.4%;
p
value = 0.199). LOS was significantly lower in the post-intervention group; mean (interquartile range) 2 (1–2) days vs. 1 (1–2) day,
p
value < 0.001. On multivariate analysis, the post-intervention group had 0.74 (95% confidence interval 0.65–0.85;
p
value < 0.001) times lower LOS as compared to pre-intervention group. Patients with DM had a significantly longer LOS (relative risk: 1.22;
p
= 0.018). No other covariates were associated with LOS (
p
value < 0.05 for all). BSTOP analysis found a significant difference between the two groups. Discharge on opioids decreased from 40.6% pre-intervention to 7.1% post-intervention.
Conclusion
ERAS and BSTOP protocols reduced length of stay and opioid need at discharge without an increase in complication or readmission rates.
Graphical Abstract</description><identifier>ISSN: 0960-8923</identifier><identifier>EISSN: 1708-0428</identifier><identifier>DOI: 10.1007/s11695-023-06794-x</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Gastrointestinal surgery ; Length of stay ; Medicine ; Medicine & Public Health ; Narcotics ; Original Contributions ; Recovery (Medical) ; Surgery</subject><ispartof>Obesity surgery, 2023-10, Vol.33 (10), p.3206-3211</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-a8a34b90ee69fb6a564e76eea70dfe4b848901fed576a95d3fb78cb388d736333</citedby><cites>FETCH-LOGICAL-c352t-a8a34b90ee69fb6a564e76eea70dfe4b848901fed576a95d3fb78cb388d736333</cites><orcidid>0000-0002-7629-1663</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/s11695-023-06794-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11695-023-06794-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids></links><search><creatorcontrib>Silverstein, Jeffrey</creatorcontrib><creatorcontrib>Sohail, Amir H.</creatorcontrib><creatorcontrib>Silva-Pacheco, Tulio B.</creatorcontrib><creatorcontrib>Khayat, Adam</creatorcontrib><creatorcontrib>Amodu, Leo</creatorcontrib><creatorcontrib>Cherasard, Patricia</creatorcontrib><creatorcontrib>Levine, Jun</creatorcontrib><creatorcontrib>Goparaju, Anirudha</creatorcontrib><creatorcontrib>Kella, Venkata</creatorcontrib><creatorcontrib>Shahidul, Islam</creatorcontrib><creatorcontrib>Petrone, Patrizio</creatorcontrib><creatorcontrib>Brathwaite, Collin E. M.</creatorcontrib><title>Impact of Enhanced Recovery After Surgery (ERAS) Combined with Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) Protocol on Patient Outcomes, Length of Stay and Opioid Prescription After Bariatric Surgery</title><title>Obesity surgery</title><addtitle>OBES SURG</addtitle><description>Background
Evidence shows that 14.2% of opioid-naive patients have long-term opioid dependence after bariatric surgery. Enhanced recovery after surgery (ERAS) protocols are widely used in bariatric surgery, while bariatric surgery targeting opioid prescriptions (BSTOP) protocols were recently introduced. We will investigate the combined impact of ERAS and BSTOP protocols after bariatric surgery.
Methods
We conducted a retrospective review for patients who underwent either a sleeve gastrectomy or Roux-en-Y gastric bypass at a tertiary care center. Pre-intervention and post-intervention data were compared. Primary outcomes were length of stay (LOS), 30-day readmission, 30-day complications, and discharge on opioids. Multivariate Poisson regression with robust standard error was used to analyze LOS.
Results
There was no significant difference in 30-day emergency room visits (3.3% vs. 4.0%;
p
value = 0.631), 30-day readmission (4.4% vs. 5.4%;
p
value = 0.577) or 30-day complication rate (4.2% vs. 6.4%;
p
value = 0.199). LOS was significantly lower in the post-intervention group; mean (interquartile range) 2 (1–2) days vs. 1 (1–2) day,
p
value < 0.001. On multivariate analysis, the post-intervention group had 0.74 (95% confidence interval 0.65–0.85;
p
value < 0.001) times lower LOS as compared to pre-intervention group. Patients with DM had a significantly longer LOS (relative risk: 1.22;
p
= 0.018). No other covariates were associated with LOS (
p
value < 0.05 for all). BSTOP analysis found a significant difference between the two groups. Discharge on opioids decreased from 40.6% pre-intervention to 7.1% post-intervention.
Conclusion
ERAS and BSTOP protocols reduced length of stay and opioid need at discharge without an increase in complication or readmission rates.
Graphical Abstract</description><subject>Gastrointestinal surgery</subject><subject>Length of stay</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Narcotics</subject><subject>Original Contributions</subject><subject>Recovery (Medical)</subject><subject>Surgery</subject><issn>0960-8923</issn><issn>1708-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kdFu0zAUhiMEEmXwAlxZ4maTFnDsxLEvu6obkyq1Wsu15TgnnafGDrYD69vwLDzEngeXDk0aiKsjW9_59R99Wfa-wB8LjOtPoSiYqHJMaI5ZLcr8_kU2KWrMc1wS_jKbYMFwzgWhr7M3IdxhTApGyCR7uO4HpSNyHZrbW2U1tOgGtPsGfo-mXQSP1qPfptfPH6fzm-n6DM1c3xibuO8m3qIL5Y2K3ug_HNqoNKOxW7QcjDMtWnkI2pshGmdDirlYb5ars_TtotNuh5xFKxUN2IiWY9Suh3COFmC3KT71Wke1R8q2_4p7rPhXibfZq07tArx7nCfZl8v5ZvY5XyyvrmfTRa5pRWKuuKJlIzAAE13DVMVKqBmAqnHbQdnwkgtcdNBWNVOiamnX1Fw3lPO2poxSepKdHnMH776OEKLsTdCw2ykLbgyScIbLZIQd0A_P0Ds3epvaHSiW_AguEkWOlPYuBA-dHLzpld_LAsuDanlULZNq-Vu1vE9L9LgUEmzT_U_R_9n6Ba30sas</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Silverstein, Jeffrey</creator><creator>Sohail, Amir H.</creator><creator>Silva-Pacheco, Tulio B.</creator><creator>Khayat, Adam</creator><creator>Amodu, Leo</creator><creator>Cherasard, Patricia</creator><creator>Levine, Jun</creator><creator>Goparaju, Anirudha</creator><creator>Kella, Venkata</creator><creator>Shahidul, Islam</creator><creator>Petrone, Patrizio</creator><creator>Brathwaite, Collin E. M.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</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>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7629-1663</orcidid></search><sort><creationdate>20231001</creationdate><title>Impact of Enhanced Recovery After Surgery (ERAS) Combined with Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) Protocol on Patient Outcomes, Length of Stay and Opioid Prescription After Bariatric Surgery</title><author>Silverstein, Jeffrey ; Sohail, Amir H. ; Silva-Pacheco, Tulio B. ; Khayat, Adam ; Amodu, Leo ; Cherasard, Patricia ; Levine, Jun ; Goparaju, Anirudha ; Kella, Venkata ; Shahidul, Islam ; Petrone, Patrizio ; Brathwaite, Collin E. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-a8a34b90ee69fb6a564e76eea70dfe4b848901fed576a95d3fb78cb388d736333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Gastrointestinal surgery</topic><topic>Length of stay</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Narcotics</topic><topic>Original Contributions</topic><topic>Recovery (Medical)</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Silverstein, Jeffrey</creatorcontrib><creatorcontrib>Sohail, Amir H.</creatorcontrib><creatorcontrib>Silva-Pacheco, Tulio B.</creatorcontrib><creatorcontrib>Khayat, Adam</creatorcontrib><creatorcontrib>Amodu, Leo</creatorcontrib><creatorcontrib>Cherasard, Patricia</creatorcontrib><creatorcontrib>Levine, Jun</creatorcontrib><creatorcontrib>Goparaju, Anirudha</creatorcontrib><creatorcontrib>Kella, Venkata</creatorcontrib><creatorcontrib>Shahidul, Islam</creatorcontrib><creatorcontrib>Petrone, Patrizio</creatorcontrib><creatorcontrib>Brathwaite, Collin E. M.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</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>Public Health Database</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>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Obesity surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Silverstein, Jeffrey</au><au>Sohail, Amir H.</au><au>Silva-Pacheco, Tulio B.</au><au>Khayat, Adam</au><au>Amodu, Leo</au><au>Cherasard, Patricia</au><au>Levine, Jun</au><au>Goparaju, Anirudha</au><au>Kella, Venkata</au><au>Shahidul, Islam</au><au>Petrone, Patrizio</au><au>Brathwaite, Collin E. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Enhanced Recovery After Surgery (ERAS) Combined with Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) Protocol on Patient Outcomes, Length of Stay and Opioid Prescription After Bariatric Surgery</atitle><jtitle>Obesity surgery</jtitle><stitle>OBES SURG</stitle><date>2023-10-01</date><risdate>2023</risdate><volume>33</volume><issue>10</issue><spage>3206</spage><epage>3211</epage><pages>3206-3211</pages><issn>0960-8923</issn><eissn>1708-0428</eissn><abstract>Background
Evidence shows that 14.2% of opioid-naive patients have long-term opioid dependence after bariatric surgery. Enhanced recovery after surgery (ERAS) protocols are widely used in bariatric surgery, while bariatric surgery targeting opioid prescriptions (BSTOP) protocols were recently introduced. We will investigate the combined impact of ERAS and BSTOP protocols after bariatric surgery.
Methods
We conducted a retrospective review for patients who underwent either a sleeve gastrectomy or Roux-en-Y gastric bypass at a tertiary care center. Pre-intervention and post-intervention data were compared. Primary outcomes were length of stay (LOS), 30-day readmission, 30-day complications, and discharge on opioids. Multivariate Poisson regression with robust standard error was used to analyze LOS.
Results
There was no significant difference in 30-day emergency room visits (3.3% vs. 4.0%;
p
value = 0.631), 30-day readmission (4.4% vs. 5.4%;
p
value = 0.577) or 30-day complication rate (4.2% vs. 6.4%;
p
value = 0.199). LOS was significantly lower in the post-intervention group; mean (interquartile range) 2 (1–2) days vs. 1 (1–2) day,
p
value < 0.001. On multivariate analysis, the post-intervention group had 0.74 (95% confidence interval 0.65–0.85;
p
value < 0.001) times lower LOS as compared to pre-intervention group. Patients with DM had a significantly longer LOS (relative risk: 1.22;
p
= 0.018). No other covariates were associated with LOS (
p
value < 0.05 for all). BSTOP analysis found a significant difference between the two groups. Discharge on opioids decreased from 40.6% pre-intervention to 7.1% post-intervention.
Conclusion
ERAS and BSTOP protocols reduced length of stay and opioid need at discharge without an increase in complication or readmission rates.
Graphical Abstract</abstract><cop>New York</cop><pub>Springer US</pub><doi>10.1007/s11695-023-06794-x</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-7629-1663</orcidid></addata></record> |
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| language | eng |
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| source | SpringerLink Journals |
| subjects | Gastrointestinal surgery Length of stay Medicine Medicine & Public Health Narcotics Original Contributions Recovery (Medical) Surgery |
| title | Impact of Enhanced Recovery After Surgery (ERAS) Combined with Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) Protocol on Patient Outcomes, Length of Stay and Opioid Prescription After Bariatric Surgery |
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