Enhanced Recovery for Patients Undergoing Metabolic Bariatric Surgery in a Community Hospital: A Retrospective Pre–Post Quality Improvement Study

BACKGROUND: A standardized, multimodal Enhanced Recovery After Surgery (ERAS) protocol was implemented to improve postoperative outcomes in patients undergoing metabolic bariatric surgery (MBS). This quality improvement initiative evaluated the impact of a standardized, multimodal ERAS protocol on postoperative outcomes in MBS patients. Implemented at a community hospital where perioperative practices were inconsistent, this evidence-based pathway introduced a structured approach to perioperative care to enhance recovery and promote safer, more efficient outcomes. METHODS: A pre- and post-quality improvement study was conducted among adults undergoing MBS at a Midwestern community hospital following implementation of a structured ERAS protocol. Patients younger than 18 years and those with long-term opioid use were excluded. The Model for Evidence-Based Practice Change guided protocol development and implementation. Pre-implementation and post-implementation cohorts were compared across primary endpoints, including PONV incidence, opioid consumption, and length of stay (LOS). Mann-Whitney U tests, and chi-square or Fisher's exact tests were used (p < .05). RESULTS: ERAS implementation resulted in a significant reduction in postoperative opioid use (Mdn = 22.5 vs. 80.0 MME; U = 143.50, p < .001). No significant differences were observed in PONV or LOS between groups. Protocol adherence was high (89.4%). CONCLUSION: A structured, multimodal ERAS protocol was an effective quality improvement strategy for patients undergoing MBS at a community hospital. Standardizing perioperative care was associated with a significant reduction in opioid requirements without increasing PONV or LOS, supporting broader adoption of ERAS pathways in bariatric surgery programs.