Impact of Tailored-Enhanced Recovery After Surgery Versus Conventional Care in Patients of Gastro-Duodenal Perforation: A Pilot Randomized Control Trial

Abstract

Background: The enhanced recovery after surgery (ERAS) program established improved clinical outcomes in elective surgery; however, its role in emergencies is uncertain. This study was designed to assess the feasibility, safety, and efficacy of a tailored-ERAS (t-ERAS) protocol in patients undergoing modified Graham’s patch closure for gastro-duodenal perforation. Methods: A single-centre, prospective, parallel-arm, open-label, randomized controlled trial was conducted from February 2021 to December 2021. Patients with gastroduodenal perforation undergoing modified Graham's patch were randomly assigned to either conventional care or the t-ERAS pathway. Patients with refractory septic shock, psychiatric or neurological disorders, pregnancy, multiple perforations, sealed-off perforations, and perforation sizes greater than 1.5 cm were excluded. The primary outcome was to compare the length of hospitalization (LOH). Functional recovery parameters and morbidity were compared in secondary outcomes. Results: Twenty-five patients each were included in conventional care and the t-ERAS group. In the t-ERAS group, LOH was significantly shorter (6.3 SD2.15 days versus 9.56 SD4.33 days, p = 0.001). Patients in the t-ERAS group had significantly early functional recovery (days) with time to first bowel sound (1.8 SD0.41; p 0.002), first flatus (2.52 SD0.65; p = 0.026), first stool (3.04 SD0.68; p < 0.001), first liquid diet (2.24 SD0.60; p = 0.002), and duration of ileus (2.64 SD0.86; p = 0.038). There was no significant difference in morbidity such as post-operative nausea and vomiting, SSI, or pulmonary complications between the two groups. Conclusion: Tailored ERAS pathways are safe and effective in reducing the LOH and promoting early functional recovery in patients undergoing emergency closure of gastro-duodenal perforation.

Fast‐track recovery after surgery for perforated peptic ulcer safely shortens hospital stay: A systematic review and meta‐analysis of six randomized controlled trials and 356 patients

“…Finally, six studies with a total cohort of 356 patients were included. [12][13][14][15][16][17] No patients were lost to follow-up. List of included studies and evidence grading as well as risk of bias are shown in Table 1.…”

“…10,11 There are several randomized controlled trials (RCTs) supporting fast-track recovery specifically after surgery for perforated peptic ulcers, but the individual cohorts are small. [12][13][14][15][16][17] The aim of this study was to evaluate fast-track recovery in this diagnosis-specific context in a larger sample focusing on the length of hospital stay and risk of complications.…”