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ERABS and renal failure

ERABS can be successfully deployed for end-stage renal failure

The authors recommended that ESRD patients should be operated only in experienced, high-volume surgical centres

A study assessing the potential benefits and safety of the Enhanced Recovery After Bariatric Surgery (ERABS) protocol for end-stage renal disease (ESRD) has found that ERABS in this population has overall minimal adverse events and lack of any ERABS-related complications. The study researchers from Medical University of Gdansk, Gdansk, Poland, Franciscus Gasthuis and Vlietland, Rotterdam and Catharina Hospital, Eindhoven, The Netherlands, said that although further research is needed to substantiate these outcomes, fast-track care appears to be safe and efficient for ESRD patients undergoing bariatric surgery.

The paper, ‘Applying Enhanced Recovery After Bariatric Surgery (ERABS) Protocol for Morbidly Obese Patients With End-Stage Renal Failure’, published in Obesity Surgery, evaluated the potential benefits and safety of the ERABS protocol for ESRD morbidly obese patients compared with non-ESRD patients with morbid obesity undergoing bariatric surgery.

A retrospective review of a prospectively collected database was performed for ESRD patients who underwent bariatric surgery according to the ERABS protocol. The primary endpoint was the length of hospital stay in days and secondary endpoints were the number of re-admissions, re-operations, length of renal replacement therapy, and complications during admission and within 30 days after surgery.

Outcomes

From 2015, 1,199 non-ESRD patients and 21 with ESRD were operated, subsequent propensity score matching resulted in two groups of 19 patients. Gastric bypass operation was performed on patients with ESRD and a sleeve gastrectomy was performed in one patient. One patient In the ESRD group had a serious complication (rated as Clavien-Dindo IIIb and IVb) for a gastrojejunal anastomosis leak and underwent revisional surgery). In this case, the length of hospital stay reached 26 days. The hospitalisation time was 3.8±0.5 day (excluding the one case where the length reached 26 days) comparing with non-ESRD patients undergoing bariatric surgery where the average hospital stay was 2.1±0.5 day (ESRD is on average 1.8 days longer than for non-ESRD due to the need of postoperative dialysis).

Overall, the complication rate was comparable and not significantly different compared with the non-ESRD group. ERABS protocol compliance was 100% for all elements of the protocol, except pre-operative counselling was 98% for non-ESRD patients.

The authors recommended that ESRD patients should be operated only in experienced, high-volume surgical centres.

“The results of our study show that patients with ESRD despite their complexity can be safety operated using ERABS protocol,” the authors concluded. Our study confirms that the use of the ERABS protocol in these morbidly obese patients with ESRD allows maintaining the quality as well as the efficiency of surgery while ensuring the highest safety standards.”

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