Mid-term Results of an ERAS Program of Bariatric Surgery in a Tertiary Referral Center.

Autor: Lacroix C; Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France., Zamparini M; Department of Anesthesia, University Hospital of Caen, Caen, France., Meunier H; Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France., Fiant AL; Department of Anesthesia, University Hospital of Caen, Caen, France., Le Roux Y; Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France., Bion AL; Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France., Savey V; Department of Nutrition, University Hospital of Caen, Caen, France., Alves A; Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France.; UNICAEN, INSERM, ANTICIPE, Normandie Univ, 14000, Caen, France., Menahem B; Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France. menahem-b@chu-caen.fr.; UNICAEN, INSERM, ANTICIPE, Normandie Univ, 14000, Caen, France. menahem-b@chu-caen.fr.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2023 Jul; Vol. 47 (7), pp. 1597-1606. Date of Electronic Publication: 2023 May 15.
DOI: 10.1007/s00268-023-07023-3
Abstrakt: Background: To identify preoperative risk factors for discharge failure beyond postoperative day two (POD-2) in bariatric surgery ERAS program in a tertiary referral center.
Methods: all consecutive patients who underwent laparoscopic bariatric treated in accordance with ERAS protocol between January 2017 and December 2019 were included. Two groups were identified, failure of early discharge (> POD-2) (ERAS-F) and success of early discharge (≤ POD-2) (ERAS-S). Overall postoperative morbidity, unplanned readmission rates were analyzed at POD-30 and POD-90, respectively. Multivariate logistic regression was performed to determine the independent risk factors for LOS > 2 days (ERAS-F).
Results: A total of 697 consecutive patients were included, 148 (21.2%) in ERAS-F group and 549 (78.8%) in ERAS-S group. All postoperative complications at POD 90, whether medical or surgical were significantly more frequent in ERAS-F group than in ERAS-S group. Neither readmission nor unplanned consultations rates at POD 90 were significantly different between both groups. History of psychiatric disorder (p = 0.01), insulin-dependent diabetes (p < 0.0001), use of anticoagulants medicine (p < 0.00001), distance to the referral center > 100 km (p = 0.006), gallbladder lithiasis (p = 0.02), and planned additional procedures (p = 0.01) were independent risk factors for delayed discharge beyond POD-2.
Conclusions: One in five patients with bariatric surgery failed to discharge earlier despite the ERAS program. Knowledge of these preoperative risk factors would allow us to identify patients who need more recovery time and a tailored approach to the ERAS protocol.
(© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)
Databáze: MEDLINE
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