Enhanced Recovery After Surgery Reduces Complications and Length of Stay in Metabolic and Bariatric Surgery: A 1,800-Patient Middle Eastern Study.

INTRODUCTION

Enhanced Recovery After Surgery (ERAS) protocols have shown benefits in various surgical specialties. However, their impact on metabolic and bariatric surgery (MBS) outcomes in the Middle East remains understudied, despite the increasing number of MBS in the region. This study aimed to evaluate the effects of implementing an ERAS protocol on patients undergoing primary MBS in a Middle Eastern population.

METHODS AND PROCEDURES

We conducted a retrospective analysis from patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between January 2019 and December 2023. The ERAS protocol was implemented in October 2021. The primary outcomes evaluated were postoperative complications and length of stay (LOS). Mann-Whitney U and Fisher's Exact tests were used to evaluate differences in LOS and rates of serious complications, respectively, between non- and ERAS implementation groups.

RESULTS

A total of 1802 patients were included in the study, with 913 in the non-ERAS group and 889 in the ERAS group. Baseline characteristics showed no significant differences between groups in age (non-ERAS: 35.02 ± 11.20 years vs ERAS: 34.31 ± 11.32 years, p = 0.165) or gender distribution (non-ERAS: 59.15% female vs ERAS: 65.80% female, p = 0.004). Mean preoperative Body Mass Index (BMI) was similar (non-ERAS: 42.75 ± 6.25 kg/m vs ERAS: 42.38 ± 6.65 kg/m, p = 0.029). Procedure distribution was comparable, with SG accounting for 59.26% in non-ERAS and 71.20% in ERAS groups (p < 0.001). Obesity related diseases such as diabetes (non-ERAS: 22.02% vs ERAS: 20.58%, p < 0.001) and hypertension (non-ERAS: 19.61% vs ERAS: 14.29%, p < 0.001) were significantly lower in the ERAS group. After ERAS implementation, the overall mean LOS decreased significantly from 42.7 h to 33.4 h (p < 0.001) representing a 21.9% reduction. This reduction was consistent across both SG (24.9% decrease, p < 0.001) and RYGB (15.7% decrease, p < 0.00) procedures. The rate of major complications (Clavien-Dindo grade III-IV) within 30 days decreased from 5.3% in the non-ERAS group to 2.5% in the ERAS group (OR 0.46, 95% CI 0.28-0.75, p < 0.001). This reduction was more pronounced in RYGB patients (8.4% to 3.8%, p = 0.02) compared to SG patients (3.8% to 1.9%, p = 0.33). Specific complications showing notable reductions in the ERAS group included superficial incisional surgical site infection (0.11% ERAS vs. 0.99% non-ERAS, p = 0.021) and acute renal failure (0% vs. 0.11%, p < 0.001).

CONCLUSION

ERAS protocol significantly reduced major postoperative complications and length of stay in a Middle Eastern population, despite similar baseline characteristics between groups. These findings support the adoption of ERAS protocols in bariatric centers to enhance patient outcomes across the region.