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3-3c_HRT1215-Session_LEMANU_CMDHB_NZ

Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012. Enhanced Recovery After Laparoscopic Sleeve Gastrectomy: A Randomised Controlled Trial Presenter: Daniel Peter Lemanu. 1. South Auckland Clinical School, School of Medicine, Faculty of Medical and

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3-3c_HRT1215-Session_LEMANU_CMDHB_NZ

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  1. Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Enhanced Recovery After Laparoscopic Sleeve Gastrectomy: A Randomised Controlled TrialPresenter: Daniel Peter Lemanu 1. South Auckland Clinical School, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, NEW ZEALAND 2. Middlemore Hospital, Counties Manukau District Health Board, NEW ZEALAND 3-3c_HRT1215-Session_LEMANU_CMDHB_NZ

  2. KEY PROBLEM Bariatric Surgery Treat severe obesity Cure obesity related comorbidity Laparoscopic Sleeve Gastrectomy offered at CMDHB Associated with significant perioperative morbidity Prolong convalescence Impair surgical recovery Enhanced Recovery After Surgery (ERAS) protocols Multiple evidence-based perioperative care interventions to optimise and standardise perioperative care Reduce morbidity and length of stay (LOS) in other types of surgery Comparably less evidence in bariatric surgery

  3. AIM OF THIS INNOVATION Aim: To investigate whether a bariatric specific ERAS protocol was effective at improving recovery after LSG A randomised controlled trial was conducted to investigate the efficacy and safety of an ERAS protocol Exposure arm (EG): Perioperative care according to ERAS Control arm (CG): Standard perioperative care Matched propensity scores used to generate an historical control group (HCG) to account for potential cross over as a result of inadequate blinding Primary outcome: Reduction in LOS from 3 days to 1 day requiring 38 patients in each arm Other outcomes: Postoperative complications, readmission rates, postoperative fatigue, protocol compliance, perioperative costs

  4. BASELINE DATA All procedures performed at the Manukau Surgery Centre, Auckland, New Zealand 400 patients had LSG between 2006 and 2010 Primary outcome: Reduction in LOS from 3 days to 1 day Other outcomes: Postoperative complications, readmission rates, perioperative costs ($NZ)

  5. KEY CHANGES IMPLEMENTED

  6. KEY CHANGES IMPLEMENTED

  7. OUTCOMES SO FAR aSignficantly reduced in ERAS group compared to both non-ERAS and historical group bSignifcantly reduced in non-ERAS group compared to historical group

  8. OUTCOMES SO FAR aSignificant reduction in the Exposure Group when compared to the Historical Group bSignificant reduction in the Control Group when compared to the Historical Group

  9. LESSONS LEARNT A bariatric specific ERAS protocol reduced LOS after surgery and was cost effective without increasing perioperative morbidity

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