DOI: https://dx.doi.org/10.18203/2349-2902.isj20215142
Published: 2021-12-28

Enhanced recovery after surgery protocol versus conventional care in emergency abdominal trauma surgery: a prospective, randomised, controlled study

Ajay Kumar Dhiman, Nilesh Jagne, Madhur Uniyal, Ajay Kumar, Quamar Azam

Abstract


Background: Since 1990s there has been a defined role of ERAS in elective surgeries, to optimize the peri-operative care, reducing post-operative complications and length of stay and hence, the overall costs. However, there is paucity of literature in its effectiveness in emergency trauma surgeries. The aim of the study was to investigate the feasibility and outcomes of ERAS protocol in emergency abdominal surgery in the setting of trauma.

Methods: Institutional IEC approved study. A prospective randomized of 52 patients with abdominal trauma undergoing emergency laprotomy were included in the study and divided into two groups: ERP and conventional group. The ERP included early feeding, early urinary catheter removal, early mobilization/physiotherapy, early intravenous line removal and early optimal oral analgesia. The primary end-points were the length of hospital stay and secondary end-points included complication rate and re-admission rate.

Results: The two groups were comparable with regards to age, gender, mechanism of injury and ISS score. Hospital stay was significantly shorter in the ERAS group: 4.67 days verses 13.36 days (p<0.001). There were 15 and 11 complications in the control and study group respectively. When graded as per the Clavien-Dindo classification there was no significant difference in the 2 groups (p=0.306).

Conclusions: This study shows that early recovery programs can be successfully implemented with significant shorter hospital stays without any increase in postoperative complications in trauma patients undergoing emergency laparotomy for abdominal trauma.


Keywords


ERAS, Conventional protocol, Emergency laparotomy, Trauma surgery

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References


Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606-17.

Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, Meyenfeldt MF, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961-9.

Wind J, Polle SW, Fung KPH, Dejong CH, Meyenfeldt MF, Ubbink DT, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93(7):800-9.

Podore PC, Throop EB. Infrarenal aortic surgery with a 3-day hospital stay: A report on success with a clinical pathway. J Vasc Surg. 1999;29(5):787-92.

Tovar EA, Roethe RA, Weissig MD, Lloyd RE, Patel GR. One-day admission for lung lobectomy: an incidental result of a clinical pathway. Ann Thorac Surg. 1998;65(3):803-6.

Gonenc M, Dural AC, Celik F, Akarsu C, Kocatas A, Kalayci MU, et al. Enhanced postoperative recovery pathways in emergency surgery: a randomised controlled clinical trial. Am J Surg. 2014;207(6):807-14.

King PM, Blazeby JM, Ewings P, Longman RJ, Kipling RM, Franks PJ, et al. The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Dis. 2006;8(6):506-13.

Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149(6):830-40.

Lohsiriwat V. Enhanced recovery after surgery for emergency colorectal surgery: Are there any differences between intra-abdominal infection and other indications? J Visc Surg. 2019;156(6):489-96.

Wisely JC, Barclay KL. Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients. ANZ J Surg. 2016;86(11):883-8.

Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T, et al. Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC Surg. 2017;17(1):18.