ERAS After Bariatric Surgery in Morbidly Obese

Study Overview
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Brief Summary
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Recently, the number of bariatric surgery is increasing but ERAS (Enhanced Recovery After Surgery) protocol for bariatric surgery needs revision with evidence. So we investigated usefulness of ERAS protocol for bariatric surgery in morbidly obese patients.

Detailed Description
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Patients undergoing elective laparoscopic bariatric surgery are going to be recruited and divided into 2 groups: Group E will receive ERAS protocol, and Group C will receive standard perioperative care. ERAS protocol comprises 8 hours of fasting and ingestion of oral carbohydrate 2 hour before surgery, TIVA(Total intra-venous anesthesia), TAP(transversus abdominis plane) block and IV-PCA using NSAIDs after surgery, and resumption of oral intake 2 hour after surgery. Conventional anesthesia is composed of 8 hours of fasting, inhalation anesthesia, IV-PCA using NSAIDs, and resumption oral intake 6 hour after surgery. In both groups, gastric ultrasonography will be used to measure gastric volume before surgery. Functional hospital stay will be recorded from the end of surgery until all discharge criteria had been met. Pain scores will be recorded at 30 minutes, 4 hours, and 24 hours after surgery. Also, nausea and vomiting, time to ambulation, will be documented. After the patients are discharged, their charts are going to be reviewed and their medical expenses will be documented.

Official Title
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Enhanced Recovery After Bariatric Surgery(ERAS) in the Morbidly Obese Using Evidence-Based Clinical Pathways: A Prospective Observational Non-randomized Comparative Study

Conditions
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ERAS, Obesity

Intervention / Treatment
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* Procedure: ERAS protocol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists grade 1   3 BMI(Body Mass Index) ≥30 Scheduled for elective laparoscopic bariatric surgery Exclusion Criteria: American Society of Anesthesiologists grade 4 or 5 History of abdominal surgery

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| E (ERAS protocol)<br>receive ERAS protocol 8 hours of fasting and ingestion of oral carbohydrate 2 hour before surgery TIVA(Total intra-venous anesthesia) TAP(transversus abdominis plane) block IV-PCA using NSAIDs after surgery Resuming oral intake 2 hours after surgery. | Procedure: ERAS protocol<br>* E: ERAS protocol C: control<br>|
| C (Control)<br>receive standard perioperative care 8 hours of fasting before surgery Inhalation anesthesia IV-PCA using NSAIDs Resuming oral intake 6 hours after surgery. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional hospital stay | time from the end of surgery until all discharge criteria had been met | from end of surgery, until all discharge criteria had been met (an average of 3 days) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative Pain score | 100 mm scale of visual analogue scale (0 100mm) | 30 minutes, 4 hours, and 24 hours after end of surgery | 
| Rescue drug and dosage | Rescue drug and dosage for additional analgesia | 30 minutes, 4 hours, and 24 hours after end of surgery | 
| Postoperative nausea and vomiting | The presence or absence of postoperative nausea and vomiting | until patient discharge (an average of 3 days) | 
| Time to ambulation | Time to ambulation after surgery | Time to ambulation (an average of 1 day) | 
| Medical expenses | Medical expenses during inpatient (Korean won) | until patient discharge (an average of 4 days) |