ArticleMetabolism open2025
Component-based approach of enhanced recovery after surgery protocols in bariatric surgery: A systematic review and meta-analysis of randomized controlled trials.
Article in Metabolism open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Introduction: Enhanced recovery after surgery (ERAS) protocols are evidence-based care improvement processes designed to minimize and reduce the negative physiological consequences of surgery. While previous studies have investigated ERAS in bariatric surgery, none have evaluated which specific components contribute most significantly to improved outcomes. Methods: We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. Six randomized controlled trials (RCTs) with total of 740 patients comparing ERAS protocols to standard care in bariatric surgery were included. We conducted component-specific meta-regression analysis of 14 individual ERAS elements, dose-response analysis across three implementation levels (low: ≤4 components, medium: 5-8 components, high: ≥9 components), and component clustering to identify synergistic combinations. Meta-regression was used to determine the relative impact of individual components on recovery and safety outcomes. Results: Six RCTs including a total of 740 patients were included. Patients randomized to ERAS protocols have experienced significant reductions in nausea and vomiting (OR: 0.42, 95 % CI: 0.19-0.95, P-value = 0.040), intraoperative time (MD: 5.40, 95 % CI: 3.05-7.77, P-value<0.001), time to mobilization (MD: 3.78, 95 % CI: 5.46 to -2.10, P-value<0.001), intensive care unit length of stay (MD: 0.70, 95 % CI: 0.13-1.27, P-value = 0.020), total hospital stay (MD: 0.42, 95 % CI: 0.69 to -0.16, P-value = 0.002), and functional hospital stay (MD: 0.60, 95 % CI: 0.98 to -0.22, P-value = 0.002). Component-based analysis demonstrated that early mobilization, anti-emetic protocols, optimized anesthesia, and multimodal analgesia contributed most significantly to improved outcomes. We observed a clear dose-response relationship, with greater benefits in studies implementing more ERAS components. Conclusion: ERAS protocols significantly improve recovery metrics following bariatric surgery, with certain components demonstrating greater impact than others. Early mobilization and anti-emetic protocols appear particularly beneficial, while the "Complete Recovery Bundle" demonstrates synergistic effects. We recommend a tiered implementation approach, prioritizing high-impact components, especially in resource-limited settings.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.