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Background

Bariatric patients with Type 2 diabetes (T2D), particularly those on insulin with advanced disease, are at increased risk of postoperative morbidity. Implementation of an ERAS protocol promotes hospital recovery and may reduce morbidity. This study examines the effects of an ERAS versus standard care (SC) protocol on surgical morbidity following Roux-en-Y gastric bypass (RYGB) for patients with T2D on or not on insulin.

Methods

The study was a retrospective analysis of 70 ERAS, 70 SC patients with T2D. 38% of patients required insulin (INS+) and 62% did not (non-INS). Outcome measures included glycemic status, complications, length of stay (LOS), 30-day readmissions, reoperations, and mortality.

Results

ERAS and SC patients were similar in age, weight, BMI, HbA1c, and co-morbidities. INS+ vs. non-INS patients within each of the protocol groups were also similar in age and BMI but INS+ patients had significantly higher HbA1c, glucose, and co-morbidities. Postoperatively, there were no significant (p>0.05) differences between ERAS and SC for glycemic status, complications, 30-day readmissions, reoperations, mortality. LOS was reduced with ERAS (1.43 vs. 1.93 days, p=0.004). The impact of ERAS on LOS was more pronounced for INS+ (1.43 vs. 2.23 days, p<0.01, ERAS vs. SC) than for non-INS patients (1.42 vs. 1.74 days, p<0.01). Under ERAS there were no significant differences in LOS (1.43 vs. 1.42 days) between INS+ and non-INS patients despite higher health risks.

Conclusions

Implementation of an ERAS protocol for RYGB patients with T2D is associated with earlier hospital discharge without significant effect on complications, readmissions, or mortality.