The ERAS Era in Bariatric Surgery: A Decade of Transformation.

BACKGROUND

Enhanced Recovery After Surgery (ERAS) protocols have transformed perioperative care in bariatric surgery over the past decade. This prospective, single-center study evaluates the implementation, evolution, and impact of ERAS protocols across a 10-year period from 2016 to 2025.

METHODS

An observational before-after cohort study using prospectively collected registry data enrolled 250 consecutive patients undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass. ERAS protocol elements were progressively implemented and refined. Outcomes included length of stay (LOS), 30-day readmission, opioid consumption, complications, and patient satisfaction (unvalidated VAS). The cohort was divided into two 5-year epochs (2016-2020 and 2021-2025).

RESULTS

Mean LOS decreased by 57%, from 2.8 ± 1.2 days to 1.2 ± 0.6 days (p < 0.001). Same-day discharge increased from 12% to 64% (p < 0.001). ERAS compliance improved from 58% to 89% (p < 0.001). Opioid consumption decreased by 72% (p < 0.001). Major complications decreased from 5 events (4.0%) to 2 events (1.6%) (p = 0.04). Thirty-day readmission rates were 3.2% in Epoch 1 versus 2.4% in Epoch 2 (p = 0.68). Patient satisfaction improved from 7.8 to 9.4 (p < 0.001) (unvalidated VAS).

CONCLUSION

ERAS protocol maturation was associated with significant reductions in LOS and opioid consumption, improved recovery, and numerically lower major complications. The study was underpowered for uncommon safety outcomes; therefore, findings support feasibility rather than definitive safety claims.