Adapted enhanced recovery after surgery pathway in emergency abdominal operations: A randomized controlled trial

Emergency abdominal surgeries comprise most of emergencies and are high-risk procedures owing to their urgency and the limited time for optimization of comorbidities. Enhanced recovery after surgery (ERAS) protocols, in an adapted form, can potentially improve patient outcomes in emergency settings. The present study aimed to evaluate the safety, efficacy, and feasibility of adapted ERAS protocols in emergency abdominal operations.

This open-label, single-center, superiority, randomized controlled trial was conducted over 18 months. Patients with acute abdomen planned for surgery were randomized preoperatively to an adapted ERAS or standard care group in a 1:1 ratio. Patients with refractory shock, coagulopathy, age < 18 years, American Society of Anesthesiologists class 4E, polytrauma, and pregnancy were excluded. The primary outcome was the length of hospitalization (LOH), whereas the secondary outcomes were functional recovery parameters and 30-day morbidity and mortality.

A total of 50 patients were analyzed in each group, showing comparable demographic and clinicopathological characteristics. The adapted ERAS group had a 6-day shorter LOH (10 [7-17] vs 16 [11-22] days, P <.001); early functional recovery in terms of reduction in time (in days) to first flatus (2.48 vs 3.14, P =.001), start of solid diet (3 vs 4, P =.035), and first stool (4 vs 5, P =.001); and a reduction in pulmonary complications (risk ratio [RR] = 0.47, P =.011). Postoperative nausea and vomiting (RR = 0.62, P =.372), surgical site infections (RR = 0.73, P =.067), and urinary tract infections (RR = 0.25, P =.092) were similar in both groups.

Adapted ERAS pathways are safe and feasible and reduce the LOH in patients undergoing emergency abdominal operations.