Enhanced Recovery in Bariatric Surgery

Enhanced recovery is a concept that has been embraced by some surgical specialties with resultant improvements in complication rates, readmissions, length of stay, and costs. While bariatric surgery is typically a pathway-driven specialty, there is a large amount of variability regarding perioperative care practices among bariatric surgery programs nationally. Enhanced recovery offers the possibility of decreasing this variability across practice settings by implementing evidence-based protocols that minimize surgical stress, maintain homeostasis, and minimize opioid use in all bariatric surgery programs. Protocols such as this also challenge surgical dogma and practices that are not supported by evidence such as “NPO after midnight,” the use of bowel preps, the use of drains and catheters, and routine imaging studies or prolonged periods without oral intake after surgery. Evidence is emerging to support the safety and effectiveness of specific components of enhanced recovery for this unique population, and, as implementation increases, the field of bariatric surgery will continue to be the leader in quality and patient safety among all surgical specialties.