Comparison Between Conventional and Enhanced Recovery After Surgery (ERAS) Protocol in Cases of Emergency Laparotomy

Area of Science:

• Perioperative Medicine
• Surgical Outcomes Research

Background:

• Enhanced Recovery After Surgery (ERAS) protocols optimize perioperative care, primarily studied in elective procedures.
• The application of ERAS in emergency laparotomy settings is less understood but holds potential for improved patient outcomes.

Purpose of the Study:

• To investigate the efficacy of a tailored ERAS care protocol in patients undergoing emergency laparotomy.
• To compare outcomes between ERAS and conventional care groups for emergency laparotomy.

Main Methods:

• A prospective randomized controlled trial involving 78 patients (ASA I-II) undergoing emergency laparotomy.
• Patients were randomized into ERAS (n=39) or conventional (CONV) groups (n=39) with blinding for patients, personnel, and investigators.
• Primary endpoint: duration of hospital stay (DHS); Secondary endpoints: postoperative morbidities, time to flatus, pain scores, and readmission rates.

Main Results:

• The ERAS group demonstrated a significantly shorter mean DHS (3.17 days vs. 7.87 days, p<0.001).
• ERAS facilitated earlier removal of nasogastric tubes and urinary catheters, earlier mobilization, and faster bowel function recovery.
• Postoperative complications, including ileus, PONV, lung issues, and SSIs, were significantly lower in the ERAS group, alongside reduced pain and opioid requirements.

Conclusions:

• A tailored ERAS protocol significantly reduces hospital stay and postoperative complications in emergency laparotomy patients.
• ERAS promotes earlier recovery milestones like mobilization and bowel function, and reduces surgical site infections and ileus.
• These findings advocate for the implementation of ERAS principles in emergency surgical care.