Modified Enhanced Recovery After Surgery (ERAS) Protocol Versus Non‐ERAS Protocol in Patients Undergoing Emergency Laparotomy for Acute Intestinal Obstruction: A Randomized Controlled Trial

Abstract

Background Enhanced Recovery After Surgery (ERAS) is a multimodal approach with promising results in improving patient outcome. Only recently, is evidence emerging highlighting how similar principles of care can be applied to patients undergoing emergency abdominal surgery. Methods A randomized controlled trial was conducted from November 2021 to April 2022 at PGIMER Chandigarh, which is a leading tertiary care hospital in northern India. 60 patients with acute intestinal obstruction requiring emergency laparotomy were randomized and assigned to ERAS or Non-ERAS group. ERAS protocol with some modifications was applied. Primary endpoints were post-operative hospital stay. Secondary end points were morbidity, 30-day readmission and mortality rate. Data analysis was done using SPSS 22.0. Independent t test or Mann-Whitney test and Chi-square or Fisher-exact test were used for analysis. Results A significant 3-day reduction in hospital stay was observed in ERAS compared to non-ERAS group (median (interquartile range) 5.50 (4.75-8.25) vs 8.0 (6.0-11.0) p = 0.003) with no difference in 30-day readmission rate, mortality rate and complication rate (according to Clavien-Dindo classification). ERAS group was associated with early recovery of gastrointestinal functions including time to first passage of flatus (p \ 0.001), stools (p = 0.014), early ambulation (p \ 0.001), time to first fluid diet (p \ 0.001), solid diet (p = 0.001) and reduced nasogastric tube reinsertion rates (p = 0.01) despite its early removal. Conclusion ERAS with some modifications can be applied in patients with intestinal obstruction. Thus, we can expedite post-operative recovery and early regain of gastrointestinal function with decreased hospital stay, comparable morbidity and mortality. Further studies are needed to assess ERAS role in emergency gastrointestinal surgeries. Trial registration Ctri.gov Identifier: CTRI/2022/04/042156.

Implementation of a perioperative registry in Ethiopia to enhance surgical quality improvement

“…28 Though we strive to increase this to rates >90%, which has been accomplished in other studies. 29,30 We used a combination of chart review and phone call follow-up, which is a commonly WORLD JOURNAL OF SURGERY accepted method. 31,32 The lack of reliable cellular phone networks and the inaccuracy of phone callderived data are two important barriers to this form of capture.…”

Clinical study of electroacupuncture on the recovery of gastrointestinal dysfunction after laparoscopic surgery for gastrointestinal cancer - study protocol for a randomized controlled trial

“…Its clinical pathway spans the entire diagnostic and treatment process, including pre-hospitalization, preoperative, intraoperative, postoperative, and post-discharge phases [ 5 ]. Based on previous studies, the adoption of the ERAS concept can significantly enhance the efficiency of surgical patient care, accelerate patient recovery, and improve postoperative quality of life [ 6 – 8 ]. In recent years, exploring other adjuvant treatment measures has become a hot topic and focus in clinical research.…”