Morbid Obesity
Conditions
Keywords
Perioperative care, Fast-track, Enhanced Recovery After Surgery, ERAS, Obesity, Bariatric surgery, Laparoscopic Sleeve Gastrectomy
Brief summary
The investigators wish to standardise and optimise perioperative care for consecutive patients undergoing laparoscopic sleeve gastrectomy for weight loss. The investigators will compare patients under a standardised perioperative care program to patients who undergo routine perioperative in our hospital and determine whether patients who had optimised perioperative care went home earlier and had fewer complications.
Interventions
OTHEREnhanced Recovery After Surgey for Sleeve Gastrectomy
Intraoperative: 1. Pre-op carbohydrate loading 2. No pre-op GIK while NBM 3. Pre-medication 4. Dexamethasone 4mg as antiemetic, IV Paracetamol (first dose) Parecoxib 40mg 5. Ondansetron regularly for first 48 hours and Cyclizine, Droperidol or Scopaderm as rescue antiemetics 6. Fluid restriction 7. Standardised method of anaesthesia 8. Give 40ml 0.5% bupivacaine with adrenaline administered prior to placement of laparoscopic port sites 9. 10ml 0.75% ropivacaine diluted to 50ml with 0.9% normal saline solution administered to surgical site prior to procedure Postoperative: 1. Rescue PCA for up to 12 hours. Oxynorm 5mg for rescue pain. Oxycontin 20mg bd/prn postoperatively 2. Maintenance IV fluids (60ml/hr plasmalyte to be stopped 0800 day 1 post op). Clear oral fluids 2 hours post op. Bariatric free oral fluids morning of day 1 3. Post operative oxygenation 4. Incentive spirometry 5. Drains (e.g. IDC) removed in recovery 6. Full mobilisation 4-8 hours post op) 7. Early Follow up
Sponsors
Auckland Medical Research Foundation
University of Auckland, New Zealand
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing laparascopic sleeve gastrectomy for weight loss by surgeons who have agreed to participate in the study * Surgery occurs at Manukau Surgery Centre
Exclusion criteria
* Surgery not occuring in Manukau Superclinic
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Length of Hospital Stay | day of discharge | The trial intends to investigate whether median length of hospital stay for patients under a standardised optimised perioperative care program is less than patients who have routine perioperative care that undergo the same operation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complications | 30 days | The study will investigate complication rate for each group identifying incidence, type and severity of complication according to the Clavien Dindo Classification system |
| Readmission rates | 30 days | The number of patients per group who represent to hospital for any reason during a 30 day period after the day of surgery |
| Postoperative fatigue | Baseline and postoperative days 1, 7 and 14 | A measure functional recovery after surgery as measured by the validated surgical recovery scale. |
| Compliance to the ERAS protocol | through to day 1 postoperatively | Prospectively recording whether components of the ERAS programme are being carried out as per protocol. |
Countries
New Zealand
Outcome results
None listed