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The obesity epidemic is swelling to epic proportions. Obese patients often suffer from a combination of hypertension, dyslipidemia, and type 2 diabetes mellitus (T2DM), also known as the "metabolic syndrome." The metabolic syndrome is an independent predictor of cardiac dysfunction and cardiovascular disease and a risk factor for perioperative morbidity and mortality. In this paper, we discuss the perioperative risk factors and the need for advanced care of obese patients needing general anesthesia for (bariatric) surgical procedures based on physiological principles.

In 2015 our hospital implemented the ERABS protocol. From that moment also morbidly obese patients with end-stage renal disease (ESRD) were enrolled. The objective of this study was to evaluate the potential benefits and safety of the ERABS protocol for ESRD morbidly obese patients compared with patients who are morbidly obese patients undergoing bariatric surgery. A retrospective review of a prospectively collected database was conducted for ESRD patients who underwent bariatric surgery according to the ERABS protocol. The primary endpoint was the length of hospital stay in days. 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. Propensity score matching was used to compare groups. From 2015 onward 1199 non-ESRD patients and 21 with ESRD were operated. Propensity score matching resulted in two groups of 19 patients. In terms of comorbidities, both groups presented typical components of metabolic syndrome. In the ESRD group, one patient had serious complications (rated as Clavien-Dindo IIIb and IVb) at the first postoperative day after OAGB. The overall complication rate was comparable and not significantly different compared with the non-ESRD group. Our study shows that ERAS in this population has overall minimal adverse events and lack of any ERAS-related complications.

Background: With the increasing prevalence of morbid obesity and healthcare costs in general, interest is shown in safe, efficient, and cost-effective bariatric care. This study describes an Enhanced Recovery After Bariatric Surgery (ERABS) protocol and the results of implementing such protocol on procedural times, length of stay in hospital (LOS), and the number of complications, such as readmissions and reoperations. Methods: Results of implementing an ERABS protocol were analyzed by comparing a cohort treated according to the ERABS protocol (2012–2014) with a cohort treated before implementing ERABS (2010–2012). Differences between both cohorts were analyzed using independent t tests and chi-squared tests. Results: A total of 1.967 patients (mean age 43.3 years, 80 % female) underwent a primary bariatric procedure between 2010 and 2014, of which 1.313 procedures were performed after implementation of ERABS. A significant decrease of procedural times and a significantly decreased LOS, from 3.2 to 2.0 nights (p < 0.001), were seen after implementation of ERABS. Significantly more complications were seen post-ERABS (16.1 vs. 20.7 %, p = 0.013), although no significant differences were seen in the number of major complications. Conclusion: Implementation of ERABS can result in shorter procedural times and a decreased LOS, which may lead to more efficient and cost-effective bariatric care. The increase in complications was possibly due to better registration of complications. The main goal of an ERABS protocol is efficient, safe, and evidence-based bariatric care, which can be achieved by standardization of the total process.