A. D. MacCormick1, A. D. MacCormick1 1University Of Auckland,Surgery,Auckland, AUCKLAND, New Zealand
Introduction:
New Zealand has some of the highest obesity rates in the world, with indigenous and Pacific populations most significantly affected. Counties Manukau Health (CMH) provides government-funded healthcare to South Auckland, a young, ethnically diverse and deprived population. CMH Bariatric Service has performed approximately 150 bariatric procedures since 2007, the vast majority being sleeve gastrectomy, and prioritizes the optimization of patient care.
Methods:
We performed a systematic review of the literature to determine the components for a bariatric enhanced recovery after surgery (ERAS) program. Subsequently we performed one of the first randomized controlled trials of ERAS versus standard care in patients undergoing Laparoscopic Sleeve Gastrectomy. Review of our five year outcomes indicated a propensity for weight regain at 18 months. We therefore conducted a systematic review looking for reasons this may occur and to determine a standard definition for weight regain.
Results:
ERAS programs are well recognized as providing important improvements in post-operative outcomes in colorectal surgery. The effects of ERAS following bariatric surgery, however, were until recently unknown. A randomized trial conducted at CMH compared ERAS to standard care and found a significant reduction in length of stay and cost in the ERAS group with no increase in complication or admission rates.
Medium and long term outcomes following sleeve gastrectomy have only been reported in recent years. Review of the five-year outcomes at CMH revealed %EWL outcomes of 60% at 18 months and 40% at five years, indicating a significant trend towards weight regain. Furthermore, the onset of the weight regain was noted to occur at the time patients were discharged from the CMH Bariatric Service suggesting that a lack of follow-up support may be associated with weight regain.
Systematic review of weight regain specifically following sleeve gastrectomy has identified a lack of follow-up support as a potential contributor to weight regain. To investigate this further, focus group discussion with almost 40 CMH sleeve gastrectomy patients who had experienced weight regain were conducted. They also identified a lack of follow-up support as a contributing factor to weight regain and expressed a desire for more long-term support. Based on these findings, a one year text message support intervention was designed and is currently being evaluated by randomized trial.
Conclusion:
Although only a relatively small center at the bottom of the world, the CMH Bariatric Service is committed to optimizing post-operative outcomes. From this body of work, contributions have been made to consensus guidelines for bariatric ERAS programs as well as to the topical issue of weight regain.