A Unique 10-year Indian Experience in Enhanced Recovery after Bariatric Surgery

Abstract

Abstract Purpose: Obesity and related morbidities impose a significant burden on the health system. Bariatric surgery has been shown to be the most effective treatment to achieve the required weight loss and reverse the metabolic syndrome. Patients with obesity essentially fall in the high-risk surgical group. Advances in the perioperative management and anesthetic techniques had resulted in enhanced recovery after surgery (ERAS). We are presenting a 10-year experience of implementing a locally pioneered ERAS protocol that predated contemporary protocols. Materials and Methods: Retrospective analysis of data of all patients who underwent bariatric surgery in a single institution from January 2012 to December 2022 was performed. Microsoft Office Excel 2007 was used for statistical analysis. Results: The 7522 patients included 2408 males and 5114 females (ratio 1:2.1). Mean age was 44.6 ± 17 years (13–81 years) and body mass index 41.9 ± 12.4 kg/m2 (26–77 kg/m2). All procedures were done laparoscopically. Procedures included sleeve gastrectomy 69% (mean operative time 39 min; standard deviation [SD] ±15 min), Roux-en-Y gastric bypass 21% (mean operative time 63 min; SD ± 17 min), and one anastomosis gastric bypass 10% (mean operative time 45 min; SD ± 7 min). Seventy percent of patients were discharged within 24 h after surgery and 1.4% hospitalized for ≥72 h. Four hundred and eighty-nine patients (6.5%) were readmitted within 30 days of surgery (96% mandated by inadequate oral intake). The incidence of early major complications was 0.3%. There was no documented mortality. Conclusion: This protocol’s long-term safety and efficacy support the current ERAS guidelines.