The value of enhanced recovery after surgery in bariatric care: a systematic review and trial sequential meta-analysis confirming reduced length of stay, costs, and nursing-sensitive complications.

BACKGROUND

Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care, but their adoption in bariatric surgery has been cautious, partly due to concerns about the safety of early oral feeding following complex procedures like gastric bypass. A comprehensive procedure-inclusive synthesis of its impact on both clinical and economic outcomes is warranted.

SETTING

Department of general surgery, the Chinese PLA general hospital first medical center.

OBJECTIVES

This systematic review and meta-analysis aimed to evaluate the impact of ERAS protocols on patients undergoing various bariatric procedures, focusing on length of stay (LOS), costs, and complications.

METHODS

We conducted a systematic review and trial sequential meta-analysis of randomized controlled trials (RCTs) and prospective cohort studies comparing ERAS with conventional care in bariatric surgery. Primary outcomes were hospital LOS and direct hospital costs; secondary outcomes included postoperative complications such as vomiting.

RESULTS

Ten studies (8 RCTs, 2 cohorts) were included. ERAS significantly reduced LOS by .95 days (weighted mean difference = -.95; 95% confidence interval [CI]: -1.40 to -.50; P < .01). The incidence of postoperative vomiting was lower in the ERAS group (odds ratio = .35; 95% CI: .17 to .71; P < .01). Trial sequential analysis indicated firm evidence for reduced LOS.

CONCLUSIONS

ERAS protocols in bariatric surgery are safe and effective, associated with faster recovery, shorter hospital stays, cost savings, and reduced vomiting. This study supports ERAS as a standard of value-based care across multiple bariatric procedures.