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Erschienen in:

23.09.2023 | Original Scientific Report

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

verfasst von: Ankit Aggarwal, Santosh Irrinki, Kailash C. Kurdia, Siddhant Khare, Naveen Naik, Cherring Tandup, Ajay Savlania, Divya Dahiya, Lileswar Kaman, Yashwant Sakaray

Erschienen in: World Journal of Surgery | Ausgabe 12/2023

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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.
Literatur
1.
Zurück zum Zitat Huddart S, Peden CJ, Swart M et al (2015) Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy. Br J Surg 102(1):57–66CrossRefPubMed Huddart S, Peden CJ, Swart M et al (2015) Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy. Br J Surg 102(1):57–66CrossRefPubMed
2.
Zurück zum Zitat Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152(3):292–298CrossRefPubMed Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152(3):292–298CrossRefPubMed
4.
Zurück zum Zitat Ni X, Jia D, Chen Y et al (2019) Is the enhanced recovery after surgery (ERAS) program effective and safe in laparoscopic colorectal cancer surgery? A meta-analysis of randomized controlled trials. World J Gastrointest Surg 23:1502–1512CrossRef Ni X, Jia D, Chen Y et al (2019) Is the enhanced recovery after surgery (ERAS) program effective and safe in laparoscopic colorectal cancer surgery? A meta-analysis of randomized controlled trials. World J Gastrointest Surg 23:1502–1512CrossRef
5.
Zurück zum Zitat Spanjersberg WR, Reurings J, Keus F et al (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev (2):CD007635 Spanjersberg WR, Reurings J, Keus F et al (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev (2):CD007635
6.
Zurück zum Zitat Al-Temimi MH, Griffee M, Enniss TM et al (2012) When is death inevitable after emergency laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg 215(4):503–511CrossRefPubMed Al-Temimi MH, Griffee M, Enniss TM et al (2012) When is death inevitable after emergency laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg 215(4):503–511CrossRefPubMed
7.
Zurück zum Zitat Shafi S, Aboutanos MB, Agarwal S Jr et al (2013) Emergency general surgery: definition and estimated burden of disease. J Trauma Acute Care Surg 74(4):1092–1097CrossRefPubMed Shafi S, Aboutanos MB, Agarwal S Jr et al (2013) Emergency general surgery: definition and estimated burden of disease. J Trauma Acute Care Surg 74(4):1092–1097CrossRefPubMed
8.
Zurück zum Zitat Ingraham AM, Ayturk MD, Kiefe CI et al (2019) Adherence to 20 emergency general surgery best practices: results of a national survey. Ann Surg 270(2):270–280CrossRefPubMed Ingraham AM, Ayturk MD, Kiefe CI et al (2019) Adherence to 20 emergency general surgery best practices: results of a national survey. Ann Surg 270(2):270–280CrossRefPubMed
9.
Zurück zum Zitat Daniel VT, Ingraham AM, Khubchandani JA et al (2019) Variations in the delivery of emergency general surgery care in the era of acute care surgery. Jt Comm J Qual Patient Saf 45(1):14–23PubMed Daniel VT, Ingraham AM, Khubchandani JA et al (2019) Variations in the delivery of emergency general surgery care in the era of acute care surgery. Jt Comm J Qual Patient Saf 45(1):14–23PubMed
10.
Zurück zum Zitat Oliver CM, Bassett MG, Poulton TE et al (2018) Organisational factors and mortality after an emergency laparotomy: multilevel analysis of 39 903 National Emergency Laparotomy Audit patients. Br J Anaesth 121(6):1346–1356CrossRefPubMed Oliver CM, Bassett MG, Poulton TE et al (2018) Organisational factors and mortality after an emergency laparotomy: multilevel analysis of 39 903 National Emergency Laparotomy Audit patients. Br J Anaesth 121(6):1346–1356CrossRefPubMed
11.
Zurück zum Zitat Ingraham AM, Cohen ME, Raval MV et al (2011) Variation in quality of care after emergency general surgery procedures in the elderly. J Am Chem Soc 212(6):1039–1048 Ingraham AM, Cohen ME, Raval MV et al (2011) Variation in quality of care after emergency general surgery procedures in the elderly. J Am Chem Soc 212(6):1039–1048
12.
Zurück zum Zitat Foss NB, Kehlet H (2020) Challenges in optimising recovery after emergency laparotomy. Anaesthesia 75(Suppl 1):e83–e89PubMed Foss NB, Kehlet H (2020) Challenges in optimising recovery after emergency laparotomy. Anaesthesia 75(Suppl 1):e83–e89PubMed
13.
14.
Zurück zum Zitat Møller MH, Adamsen S, Thomsen RW et al (2011) Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg 98(6):802–810CrossRefPubMed Møller MH, Adamsen S, Thomsen RW et al (2011) Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg 98(6):802–810CrossRefPubMed
15.
Zurück zum Zitat Wisely JC, Barclay KL (2016) Effects of an enhanced recovery after surgery programme on emergency surgical patients. ANZ J Surg 86(11):883–888CrossRefPubMed Wisely JC, Barclay KL (2016) Effects of an enhanced recovery after surgery programme on emergency surgical patients. ANZ J Surg 86(11):883–888CrossRefPubMed
17.
Zurück zum Zitat Aggarwal G, Peden CJ, Mohammed MA et al (2019) Evaluation of the collaborative use of an evidence-based care bundle in emergency laparotomy. JAMA surg 154(5):e190145–e190169CrossRefPubMedPubMedCentral Aggarwal G, Peden CJ, Mohammed MA et al (2019) Evaluation of the collaborative use of an evidence-based care bundle in emergency laparotomy. JAMA surg 154(5):e190145–e190169CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Paduraru M, Ponchietti L, Casas IM et al (2017) Enhanced recovery after surgery (ERAS)-the evidence in geriatric emergency surgery: a systematic review. Chirurgia (Bucur) 112(5):546–557CrossRefPubMed Paduraru M, Ponchietti L, Casas IM et al (2017) Enhanced recovery after surgery (ERAS)-the evidence in geriatric emergency surgery: a systematic review. Chirurgia (Bucur) 112(5):546–557CrossRefPubMed
19.
Zurück zum Zitat Gonenc M, Dural AC, Celik F et al (2014) Enhanced postoperative recovery pathways in emergency surgery: a randomised controlled clinical trial. Am J Surg 207(6):807–814CrossRefPubMed Gonenc M, Dural AC, Celik F et al (2014) Enhanced postoperative recovery pathways in emergency surgery: a randomised controlled clinical trial. Am J Surg 207(6):807–814CrossRefPubMed
20.
Zurück zum Zitat Mohsina S, Shanmugam D, Sureshkumar S et al (2018) Adapted ERAS pathway vs. standard care in patients with perforated duodenal ulcer—a randomized controlled trial. J Gastrointest Surg 22(1):107–16CrossRefPubMed Mohsina S, Shanmugam D, Sureshkumar S et al (2018) Adapted ERAS pathway vs. standard care in patients with perforated duodenal ulcer—a randomized controlled trial. J Gastrointest Surg 22(1):107–16CrossRefPubMed
21.
Zurück zum Zitat Shida D, Tagawa K, Inada K et al (2017) Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC Surg 17(1):1–6CrossRef Shida D, Tagawa K, Inada K et al (2017) Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC Surg 17(1):1–6CrossRef
22.
Zurück zum Zitat Shang Y, Guo C, Zhang D (2018) Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer: a propensity score matching analysis. Medicine (Baltimore) 97(39):e12348CrossRefPubMed Shang Y, Guo C, Zhang D (2018) Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer: a propensity score matching analysis. Medicine (Baltimore) 97(39):e12348CrossRefPubMed
23.
Zurück zum Zitat Saurabh K, Sureshkumar S, Mohsina S et al (2020) Adapted ERAS pathway versus standard care in patients undergoing emergency small bowel surgery: a randomized controlled trial. J Gastrointest Surg 24(9):2077–2087CrossRefPubMed Saurabh K, Sureshkumar S, Mohsina S et al (2020) Adapted ERAS pathway versus standard care in patients undergoing emergency small bowel surgery: a randomized controlled trial. J Gastrointest Surg 24(9):2077–2087CrossRefPubMed
24.
Zurück zum Zitat Purushothaman V, Priyadarshini P, Bagaria D et al (2021) Enhanced recovery after surgery (ERAS) in patients undergoing emergency laparotomy after trauma: a prospective, randomized controlled trial. Trauma Surg Acute Care Open 6(1):e000698CrossRefPubMedPubMedCentral Purushothaman V, Priyadarshini P, Bagaria D et al (2021) Enhanced recovery after surgery (ERAS) in patients undergoing emergency laparotomy after trauma: a prospective, randomized controlled trial. Trauma Surg Acute Care Open 6(1):e000698CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat De Cassai A, Boscolo A, Tonetti T et al (2019) Assignment of ASA-physical status relates to anesthesiologists’ experience: a survey-based national-study. Korean J Anesthesiol 72(1):53–59CrossRefPubMed De Cassai A, Boscolo A, Tonetti T et al (2019) Assignment of ASA-physical status relates to anesthesiologists’ experience: a survey-based national-study. Korean J Anesthesiol 72(1):53–59CrossRefPubMed
26.
Zurück zum Zitat Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829CrossRefPubMed Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829CrossRefPubMed
27.
Zurück zum Zitat Crichton N (2001) Visual analogue scale (VAS). J Clin Nurs 10(5):706–716 Crichton N (2001) Visual analogue scale (VAS). J Clin Nurs 10(5):706–716
28.
Zurück zum Zitat Kendrick JB, Kaye AD, Tong Y et al (2019) Goal-directed fluid therapy in the perioperative setting. J Anaesthesiol Clin Pharmacol 35(Suppl 1):S29–S34PubMedPubMedCentral Kendrick JB, Kaye AD, Tong Y et al (2019) Goal-directed fluid therapy in the perioperative setting. J Anaesthesiol Clin Pharmacol 35(Suppl 1):S29–S34PubMedPubMedCentral
29.
Zurück zum Zitat Vargas-Schaffer G (2010) Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 56(6):514–517PubMedPubMedCentral Vargas-Schaffer G (2010) Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 56(6):514–517PubMedPubMedCentral
30.
Zurück zum Zitat Clavien PA, Barkun J, De Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed Clavien PA, Barkun J, De Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed
31.
Zurück zum Zitat Verma R, Nelson RL (2007) Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2010(3):CD004929 Verma R, Nelson RL (2007) Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2010(3):CD004929
33.
Zurück zum Zitat Cheatham ML, Chapman WC, Key SP et al (1995) A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 221(5):469CrossRefPubMedPubMedCentral Cheatham ML, Chapman WC, Key SP et al (1995) A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 221(5):469CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Rao W, Zhang X, Zhang J et al (2011) The role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis. Int J Colorectal Dis 26(4):423–429CrossRefPubMed Rao W, Zhang X, Zhang J et al (2011) The role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis. Int J Colorectal Dis 26(4):423–429CrossRefPubMed
35.
Zurück zum Zitat Spanjersberg WR, Reurings J, Keus F et al (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev (2) Spanjersberg WR, Reurings J, Keus F et al (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev (2)
36.
Zurück zum Zitat Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17(5):962–972CrossRefPubMed Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17(5):962–972CrossRefPubMed
38.
Zurück zum Zitat Sánchez-Jiménez R, Álvarez AB, López JT et al (2014) ERAS (Enhanced Recovery after Surgery) in colorectal surgery. In: Colorectal cancer surgery, diagnostics and treatment Sánchez-Jiménez R, Álvarez AB, López JT et al (2014) ERAS (Enhanced Recovery after Surgery) in colorectal surgery. In: Colorectal cancer surgery, diagnostics and treatment
39.
Zurück zum Zitat Miller TE, Gan TJ, Thacker JK (2014) Enhanced recovery pathways for major abdominal surgery. Anesthesiol News 1–8 Miller TE, Gan TJ, Thacker JK (2014) Enhanced recovery pathways for major abdominal surgery. Anesthesiol News 1–8
Metadaten
Titel
Modified Enhanced Recovery After Surgery (ERAS) Protocol Versus Non-ERAS Protocol in Patients Undergoing Emergency Laparotomy for Acute Intestinal Obstruction: A Randomized Controlled Trial
verfasst von
Ankit Aggarwal
Santosh Irrinki
Kailash C. Kurdia
Siddhant Khare
Naveen Naik
Cherring Tandup
Ajay Savlania
Divya Dahiya
Lileswar Kaman
Yashwant Sakaray
Publikationsdatum
23.09.2023
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 12/2023
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-023-07176-1

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