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Author Notes:

Elizabeth M. Hechenbleikner, Email: ehechen@emory.edu

The authors would like to thank Theresa Evans, Cheryl Sewell, Angela Young-Hill, Amber Davis, Sharon Jenkins-Green, Carla Smach, and Victoria Delgado for their steadfast dedication and support of the enhanced recovery protocol initiative.

Drs. Hechenbleikner, Grunewald, Sanford, Diller, Oyefule, Serrot, and Srinivasan as well as Mr. Gillingham and Ms. Jannuzzo have no conflicts of interest or financial ties to disclose. Ms. Majumdar has received honoraria for participation in the Academy of Nutrition and Dietetics Food and Nutrition Conference and Expo and the Weight Management Dietetic Practice Group webinar. Dr. Stetler has a leadership position in the Georgia ASMBS chapter and has received payment or honoraria for involvement in the SAGES robotic surgery fellow course. Dr. Lin has leadership roles in the Fellowship Council and Southeastern Surgical congress and has received payment for expert testimony related to gastrostomy tube complications. Dr. Davis had a research grant from C. R. Bard, Inc. (Bard) which ended in 2020 and has received payment for expert testimony in several malpractice cases. Dr. Patel receives payment or honoraria for Intuitive Surgical, Inc. proctoring as well as SAGES course director roles.


Research Funding:



  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery
  • Bariatric surgery
  • Enhanced recovery
  • Quality improvement
  • Standard work
  • CARE

S136-operationalizing an enhanced recovery protocol after bariatric surgery: single institutional pilot experience forging data-driven standard work

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, Pages 1-9

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Article | Final Publisher PDF


Background: Enhanced recovery protocols (ERPs) after metabolic and bariatric surgery (MBS) may help decrease length of stay (LOS) and postoperative nausea/vomiting but implementation is often fraught with challenges. The primary aim of this pilot study was to standardize a MBS ERP with a real-time data support dashboard and checklist and assess impact on global and individual element compliance. The secondary aim was to evaluate 30 day outcomes including LOS, hospital readmissions, and re-operations. Methods and procedures: An ERP, paper checklist, and virtual dashboard aligned on MBS patient care elements for pre-, intra-, and post-operative phases of care were developed and sequentially deployed. The dashboard includes surgical volumes, operative times, ERP compliance, and 30 day outcomes over a rolling 18 month period. Overall and individual element ERP compliance and outcomes were compared pre- and post-implementation via two-tailed Student’s t-tests. Results: Overall, 471 patients were identified (pre-implementation: 193; post-implementation: 278). Baseline monthly average compliance rates for all patient care elements were 1.7%, 3.7%, and 6.2% for pre-, intra-, and post-operative phases, respectively. Following ERP integration with dashboard and checklist, the intra-operative phase achieved the highest overall monthly average compliance at 31.3% (P < 0.01). Following the intervention, pre-operative acetaminophen administration had the highest monthly mean compliance at ≥ 99.1%. Overall TAP block use increased 3.2-fold from a baseline mean rate of 25.4–80.8% post-implementation (P < 0.01). A significant decrease in average intra-operative monthly morphine milligram equivalents use was noted with a 56% drop pre- vs. post-implementation. Average LOS decreased from 2.0 to 1.7 days post-implementation with no impact on post-operative outcomes. Conclusion: Implementation of a checklist and dashboard facilitated ERP integration and adoption of process measures with many improvements in compliance but no impact on 30 day outcomes. Further research is required to understand how clinical support tools can impact ERP adoption among MBS patients.
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