Background With obesity prevalence projected to increase, the demand for bariatric surgery will consequently rise. Enhanced recovery programmes aim for improved recovery, earlier discharge, and more efficient use of resources following surgery. This systematic literature review aimed to evaluate the evidence available on the effects of enhanced recovery programmes after three common bariatric procedures: laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), and one anastomosis gastric bypass (OAGB). Methods MEDLINE, Embase, the Cochrane Library and the National Health Service Economic Evaluation Database were searched for studies published in 2012-2019 comparing outcomes with enhanced recovery programmes versus conventional care after bariatric surgery in Europe, the Middle East and Africa. Data were extracted and meta-analyses or descriptive analyses performed when appropriate using R. Results Of 1152 screened articles, seven relevant studies including 3592 patients were identified. Six reported outcomes for 1434 patients undergoing LRYGB; however, as only individual studies reported on LSG and OAGB these could not be included in the analyses. The metaanalysis revealed a significantly shorter mean duration of hospital-stay for LRYGB enhanced recovery programmes than conventional care (mean difference [95% CI]: -1.34 days [-2.01, -0.67]; p<0.0001), supported by sensitivity analysis excluding retrospective studies. Meta-analysis found no significant difference in 30-day readmission rate (risk ratio [95% CI]: 1.39 [0.84, 2.28]; p = 0.2010). Complication rates were inconsistently reported by Clavien-Dindo grade, but descriptive analysis showed generally higher low-grade rates for enhanced recovery programmes; the trend reversed for high-grade complications. Reoperation rates were rarely reported; no significant differences were seen. Conclusion These results support enhanced recovery programmes allowing shorter inpatient stay without significant differences in readmission rate following LRYGB, although complication and reoperation rate comparisons were inconclusive. Further research is needed to fill current data gaps including the lack of studies on LSG and OAGB.
Bibliographical noteFunding Information:
This study was sponsored by Johnson & Johnson Medical NV. CT, HT, KM and TN are employees of Johnson & Johnson. KA, CR, SS and WMserved as paid consultants for Johnson & Johnson. The funder provided support in the form of salaries for CT, HT, KM and TN, remuneration for KA, CR, SS and WM, and contributed to the study design, data collection and analysis, decision to publish, and preparation of the manuscript. The specific roles of these authors are articulated in the 'author contributions' section. All authors had full access to the data, reviewed and approved the final version, and were responsible for the decision to submit for publication. A medical writing agency, employed by the funder, assisted with manuscript preparation under the authors' direction.
© 2020 Al-Rubeaan et al.