Enhanced recovery after bariatric surgery: a comprehensive survey-based analysis of ERABS actual clinical implementation in Italian bariatric centers
Authors: Castagneto-Gissey Lidia , Russo Maria Francesca , Diddoro Annalisa , De Luca Maurizio , Musella Mario , Navarra Giuseppe , Piazza Luigi , Zappa Marco Antonio , Raffaelli Marco , Di Lorenzo Nicola , Casella Giovanni ,   Collaborative Group, Fabrizio Altorio Settimo , Antonio Ambrosi , Lucchi Andrea , Porta Andrea , Paolo Baccari , Alessandro Balani , Domenico Barbato , Ugo Bardi , Marco Battistoni , Rosario Bellini , Halim Berjaoui Abdul , Paolo Bernante , Lilia Bertolani , Sodano Biagio , Pietro Bianchi Paolo , Luigi Boni , Vincenzo Bottino , Cosimo Callari , Francesco Caruso , Marco Catarci , Giuseppe Cavallaro , Maurizio Cesari , Franco Ciampaglia , Luigi Cobellis , Marco Comaschi , Vittorio Corso , Stefano Cristiano , Diego Cuccurullo , Marco De Paoli , Giancarlo Di Marzo , Massimiliano Di Paola , Ludovico Docimo , Altomare Donato Francesco , Facchiano Enrico , Giovanni Fantola , Cristiano Finco , Mirto Foletto , Andrea Gambetti , Paolo Gentileschi , Sarro Giuliano , Sarra Giuseppe , Pignata Giusto , Guerrieri Mario , Giuseppe La Malfa , Ezio Lattuada , Mauro Longoni , Marcello Lucchese , Giuseppe Manca , Federico Marchesi , Maria Marinari Giuseppe , Bernardo Marzano , Giuseppe Mastrandrea , Giovanni Merola , Roberto Moroni , Stefano Olmi , Alessandro M. Paganini , Andrea Peri , Nicola Perrotta , Micaela Piccoli , Cutolo Pierpaolo , Francesco Pizza , Pietro Pizzi Mattia Edoardo , Salatto Potito , Andrea Rizzi , Gianluca Rossetti , Giacomo Ruffo , Marco Scalambra , Michele Schettino Angelo , Marcello Spampinato , Francesco Stipa , Giuseppe Vuolo 
Published: October 2024

The escalating global prevalence of bariatric procedures necessitates an enhanced focus on optimizing perioperative care for improved patient outcomes. This study focuses on the implementation of Enhanced Recovery After Bariatric Surgery (ERABS) protocols in Italian bariatric centers to optimize perioperative care. An online survey comprising 19 items was conducted in October 2023, targeting managing surgeons in 139 registered bariatric centers. This survey explored geographic and center-type variations, knowledge, and application of ERABS protocols, along with perioperative, intraoperative, and postoperative practices. Statistical analysis employed included one-way ANOVA and Tukey post hoc tests. Responses from 72 centers (51.8%) revealed a strong awareness of ERABS protocols among managing surgeons. Adherence rates varied geographically (46.3–63%) and among center types (60.8–56.3%). Perioperative practices, including the abandonment of antibiotics for perioperative prophylaxis by 77.5% of surgeons and the adoption of the TAP block technique in 69% of centers, aligned well with ERABS recommendations. However, inconsistencies were noted in abdominal drain usage (61.5% after SG; 70.5% after RYGB/OAGB), with a substantial percentage not adhering to ERABS guidelines. Intraoperative habits generally adhered to ERABS protocols, yet preferences for certain tests, particularly the methylene blue test (70.4%), deviated. Postoperative practices displayed positive trends, with early reintroduction of oral feeding (71.8%) and opioid-free pain management (71.8%). Variations existed in discharge timing and patient monitoring, indicating areas for further improvement. This study offers a comprehensive snapshot of ERABS protocol adherence in Italy, emphasizing the positive trend toward optimizing recovery and reducing patient stress. Despite variations, a majority of centers demonstrated commitment to ERABS principles. Ongoing education, interdisciplinary collaboration, and nationwide dialogue are essential for standardizing ERABS protocols and advancing bariatric–metabolic surgery outcomes in Italy.