Comparative outcomes of ERAS and conventional methods in laparoscopic sleeve gastrectomy: a 5-Year prospective cohort study in Saudi Arabia.

Background: The burden of obesity in Saudi Arabia is partly addressed with Laparoscopic Sleeve Gastrectomy (LSG), a bariatric surgical option, but perioperative complications and prolonged hospital stays persist. Enhanced Recovery After Surgery (ERAS) aims to improve postoperative outcomes.

Objectives: To compare the peri-operative LSG outcomes among patients receiving ERAS and conventional bariatric procedures (non-ERAS).

Methods: A prospective cohort study design involving patients receiving conventional LSG care (non-ERAS) (n = 50) and those receiving ERAS protocol (n = 44) at International Medical Centre, Jeddah, Saudi Arabia. The ERAS protocol consisted of preoperative, intraoperative, and postoperative components, including patient education, fluid management, early mobilization, and pain management. Outcomes were compared between the two groups in terms of length of stay, postoperative ambulation, Clavien-Dindo graded postoperative complications, 30-day readmission, mortality and healthcare costs, followed by a five-year follow-up.

Results: In total the number of participants was 94 patients. The ERAS group had a slightly shorter length of stay (2.05 days vs. 2.20 days) and significantly lower healthcare costs (SAR43,337 vs. SAR46,040, p < 0.05) compared to the non-ERAS group. The ERAS group had a lower incidence of postoperative Clavien-Dindo-graded complications, including wound infection, atelectasis, and pneumonia. The total length of the surgical procedure did not differ significantly (p < 0.05). Remarkably, 100% of patients in the ERAS group were out-of-bed on postoperative day (POD) zero compared to only 25% in the non-ERAS group. On the day of the operation, a greater percentage of patients in the ERAS group (58%) began oral intake than in the conventional care group (42%). There were no observable statistical differences in analgesic benefits in both groups (p = 0.543), 6 h after discharge from the post-anaesthesia care unit and at POD 1 (p = 0.08). At 5-year follow-up, the ERAS group had a better prognosis with fewer complications. At 5-year follow-up, a higher percentage of the ERAS group did not report any complication compared to the non-ERAS group (61% vs. 51%).

Conclusion: Implementation of ERAS in LSG improved postoperative outcomes, including shorter length of stay, better mobilization, lower healthcare costs, and fewer complications. This demonstrates the effectiveness of ERAS in LSG and provides valuable insights for improving perioperative bariatric care practices.