Evidence map›Paper›PMID 40612698›Full record

ArticleMetabolism open2025

Component-based approach of enhanced recovery after surgery protocols in bariatric surgery: A systematic review and meta-analysis of randomized controlled trials.

Ibrahim Ezuddin M Almaski, Yazan Jumah Alalwani, Reem Salem Alshammari, Rayyan Mohammed A Alassiri, Salman Ahmed S Jathmi, Aishah Mohammed Alhadi, Amal Saleh Alzahrani, Mohammed Abdulwahed Alzahrani, Ahmed Y Azzam, Tareq A Maani

Abstract read
In one paragraph

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.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Ibrahim Ezuddin M AlmaskiCollege of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Yazan Jumah AlalwaniCollege of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Reem Salem AlshammariCollege of Medicine, Northern Border University, Arar, Saudi Arabia.
Rayyan Mohammed A AlassiriCollege of Medicine, King Khalid University, Abha, Saudi Arabia.
Salman Ahmed S JathmiCollege of Medicine, Taibah University, Al-Madinah Al-Munawra, Saudi Arabia.
Aishah Mohammed AlhadiCollege of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
Amal Saleh AlzahraniCollege of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
Mohammed Abdulwahed AlzahraniCollege of Medicine, King Khalid University, Abha, Saudi Arabia.
Ahmed Y AzzamDirector of Clinical Research and Clinical Artificial Intelligence, ASIDE Healthcare, Lewes, DE, USA.
Tareq A MaaniGeneral Surgery Consultant, Department of Surgery, King Salman Bin Abdulaziz Medical City, Madinah, Saudi Arabia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Indexed as

Bariatric surgeryComponent-based analysisEnhanced recovery after surgerySurgical outcomesSurgical recovery

Identifiers

PMID40612698
PMCPMC12221748

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

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.