Enhanced Recovery After Bariatric Surgery

Abstract

Enhanced recovery after surgery (ERAS) represents the use of a standardized, multimodal perioperative care pathway aiming to achieve early recovery after surgery. ERAS pathways aim to optimize the patient preoperatively, minimize the surgical stress response, and expedite recovery to a normal physiological state via standardized, evidence-based protocols. Enhanced recovery after bariatric surgery (ERABS) has evolved rapidly in the last decade, culminating in the publication of a number of guidelines in the last five years recommending perioperative ERABS interventions, while the evidence to support these interventions is constantly expanding. The evidence base supporting ERABS protocol implementation is robust, with a number of randomized controlled trials and meta-analyses showing convincing evidence of benefits, including decreased length of stay, pain, and risk of postoperative nausea and vomiting, while confirming the safety of ERABS interventions. Implementation of enhanced recovery protocols can be challenging and is often incomplete, limiting their effectiveness. Progress is needed toward standardizing enhanced recovery protocols in bariatric surgery to ensure consistency in implementing the best practice among bariatric centers. In order to achieve this, protocols must be generalizable so that they can be used in a variety of settings. The development of ERABS protocols has been the driving force enabling significant change to everyday practice in bariatric surgery in the last decade and has demonstrated an impressive decrease in the use of resources and hospital stay. In this chapter, we present the rationale supporting ERABS interventions, the relevant guidelines published in the last five years, and an overview of protocol recommendations and discuss the evidence supporting the use of protocols as well as their limitations.