Impact of Enhanced Recovery After Bariatric Surgery (ERABS) Protocol in Reducing Length of Stay and Hospitalization Costs: the Experience of a Philanthropic Hospital in Brazil.

Abstract

The global prevalence of obesity and increase in bariatric surgeries are burdening the healthcare system. Enhanced recovery postoperative protocols are associated with a reduction in hospitalization costs and length of stay (LOS) and may be an alternative to reduce public health expenses. To assess the impact of implementing a customized Enhanced Recovery After Bariatric Surgery (ERABS) protocol on hospitalization costs (HC), LOS, and complication rates. Santa Marcelina Hospital, São Paulo, Brazil. A retrospective electronic health record analysis of patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy and who were cared for within a clinical pathway (CP) protocol (Jan. 2016-Aug. 2018) or after implementation of an ERABS protocol (Aug. 2018-Jun. 2019). The LOS, HC, and complication, readmission, and reoperation rates were compared between the two groups. Eighty-two patients were included in the study (CP, 56, 87.5% women; ERABS, 26, 92.3% women). Hospital LOS and total HC decreased significantly by 32.5% and 15.2%, respectively (both, p < 0.05), after implementation of ERABS. There were no significant differences in 30-day readmission, complication, or reoperation rates. The implementation of a standardized enhanced recovery program resulted in reduced LOS and HC without an increase in perioperative morbidity. The ERABS protocol is cost-effective and can help ease the healthcare burden.