A. C. Kale1, D. Gunnells2, M. S. Morris1, J. A. Cannon1, D. I. Chu1, G. D. Kennedy1 1University Of Alabama at Birmingham,Gastrointestinal Surgery,Birmingham, Alabama, USA 2Ochsner Foundation Hospital,Colorectal Surgery,New Orleans, LOUISIANA, USA
Introduction:
Enhanced recovery after surgery (ERAS) pathways are multimodal, perioperative approaches to patient management that have been shown to reduce length of stay (LOS), postoperative complications, and readmissions. Our group has previously shown that ERAS decreases racial/ethnic disparity in outcomes following colorectal surgery. While it is encouraged to apply these pathways to all patients, it remains to be determined if all principles of the pathways are safe in all patient populations. Here we have examined outcomes following surgery and ERAS guided management in patients with obesity. We hypothesized that patients with obesity would have worse outcomes and higher rates of complications.
Methods:
This single center, retrospective study utilized the NSQIP database to identify patients who were managed via an ERAS pathway at our institution between 2015-2017. Patients’ BMI was stratified into NIH categories and chi squared and Wilcoxon tests were performed to determine differences in outcomes between obese and normal/overweight categories; patients classified as underweight were excluded. Analyses were also performed to delineate the impact of ERAS on the outcomes of patients with obesity using a BMI matched, pre-ERAS cohort from 2012-2014. Primary outcome was LOS. Secondary outcomes included all 30-day post-operative ACS-NSQIP complications.
Results:
A total of 1000 ERAS and 685 pre-ERAS patients were included in this study. Among ERAS patients, 61% (606/1000) were classified as normal or overweight, while 39% (394/1000) suffered from obesity. Pre-ERAS patients had comparable BMI distributions. We found that patients managed on the ERAS protocol had a significantly shorter postoperative LOS regardless of BMI compared to the Pre-ERAS patient group (5.5 vs. 7.5 days, p<0.01). While Pre-ERAS patients with obesity had higher rates of superficial surgical site infections (SSI) compared to non-obese Pre-ERAS patients, patients with obesity that were managed with ERAS had no difference in SSIs in comparison to the normal/overweight ERAS cohort (Table 1). Overall, patients who received ERAS guided care experienced a higher incidence of wound disruption in comparison to the Pre-ERAS cohort (3 vs. <1%, p<0.01). ERAS patients with obesity demonstrated significantly higher rates of this complication in comparison to non-obese, ERAS patients (Table 1).
Conclusion:
Patients with obesity have similar outcomes as patients who have normal or overweight BMIs when managed on an ERAS protocol. The use of ERAS pathways may decrease SSIs in patients with obesity, but these patients may be more susceptible to wound disruption. These data suggest that the ERAS pathway is safe and benefit all patients regardless of BMI.
