Enhanced Recovery After Surgery in Laparoscopic Sleeve Gastrectomy

While laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric
surgery procedure in the US and worldwide, it is associated with significant postoperative
nausea and vomiting (PONV), which can lead to patient readmission for rehydration and symptom
control. Enhanced recovery after surgery (ERAS) is an approach that aligns the practice of
anesthesia with the care given by the surgical team before, during, and after surgery. A
number of prospective series, retrospective analyses and one randomized clinical trial of
ERAS use in bariatric patients support the idea that ERAS in this population is feasible,
effective and safe and that it is associated with shorter lengths of stay, fewer readmissions
and decreased costs. In this protocol, the investigators will conduct a prospective,
randomized control study using a structured and integrative perioperative plan (ERAS; n = 64)
vs. current standard of care (SOC; n = 64) for patients undergoing LSG at Hartford Hospital.
The investigators are guided by the idea that an enhanced recovery protocol can potentially
serve to enhance the early patient experience and set the stage for a more rapid transition
out of the recovery phase and into the weight loss phase of the patient's care. The
investigators will incorporate a postoperative multidrug strategy targeting multiple
receptors to decrease PONV and pain, similar to ERAS Society recommendations for bariatric
patients.

Specific Aims and Hypotheses The central hypothesis is that the introduction of an ERAS
pathway in patients undergoing LSG is feasible and will lead to better clinical outcomes.

Aim 1. To evaluate the effect that introducing an ERAS pathway will have on the use of
narcotic medication for the management of postoperative pain, PONV, readiness for discharge,
and overall length of stay in patients undergoing LSG.

Aim 2. To evaluate the safety of the ERAS protocol by measuring inpatient and 30-day adverse
events, emergency department (ED) visits, outpatient hydration, readmission rates and
delirium.

Participants will be recruited through fliers posted at Surgical Weight Loss Center locations
(Glastonbury, Enfield, Hartford, Farmington, Manchester and South Windsor).