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Effect of an enhanced recovery after surgery protocol for children with acute appendicitis: A randomized controlled
Buket Meral1, Birsen Mutlu2, Hatice Sonay Yalçın Cömert3
1Karadeniz Technical University, Faculty of Health Sciences, Department of Pediatric Nursing, Trabzon, Turkey.
Insights
The modified Enhanced Recovery After Surgery (mERAS) protocol significantly shortened hospital stays and improved recovery for children undergoing appendectomy. This nurse-led approach enhances patient outcomes, including reduced pain and anxiety.
Area of Science:
- Pediatric Surgery
- Perioperative Care
- Enhanced Recovery After Surgery (ERAS) Protocols
Background:
- Enhanced Recovery After Surgery (ERAS) protocols are multimodal care pathways aimed at improving surgical recovery.
- Evidence for ERAS implementation in pediatric surgery remains limited.
- This study focuses on the modified ERAS (mERAS) protocol in pediatric appendectomy.
Purpose of the Study:
- To evaluate the effectiveness of a nurse-led, modified Enhanced Recovery After Surgery (mERAS) protocol.
- To assess the impact of the mERAS protocol on patient outcomes in children undergoing appendectomy.
- To determine if mERAS care improves postoperative recovery compared to standard care.
Main Methods:
- A single-center randomized controlled trial involving 82 children (aged 6-17) undergoing appendectomy.
- Intervention group received mERAS protocol-based care (education, bowel motility stimulation, early mobilization, non-pharmacological management).
- Control group received standard care; outcomes analyzed included length of stay, anxiety, pain, nausea, and time to mobilization/flatus.
Main Results:
- Postoperative hospital stay was significantly shorter in the mERAS group (mean difference -9.84 hours).
- Time to first postoperative mobilization and first flatus were significantly reduced in the mERAS group.
- mERAS protocol care was independently associated with a decreased risk of prolonged hospital stay.
Conclusions:
- The nurse-led mERAS protocol is an effective perioperative care model for pediatric appendectomy.
- mERAS protocol enhanced recovery, improving outcomes like pain, anxiety, and thirst.
- Findings support integrating structured, nurse-led protocols into routine pediatric surgical care.
Background:
Enhanced Recovery After Surgery protocols are multidisciplinary, multimodal perioperative care pathways to enhance recovery after surgery. Evidence regarding the implementation of these protocols in pediatric surgery is still limited.
Objective:
This study aimed to evaluate the effectiveness of nursing care based on the modified Enhanced Recovery After Surgery (mERAS) protocol on patient outcomes in children undergoing appendectomy.
Method:
This single-center randomized controlled trial included 82 children aged 6-17 years who underwent appendectomy and their parents between October 2023 and May 2024. Patients were randomly assigned to groups (1:1). The control group received standard care, and the intervention group received mERAS protocol-based care, including perioperative education, stimulation of bowel motility, early postoperative mobilization, and non-pharmacological perioperative management. The primary outcome is the postoperative length of stay. The secondary outcomes include patient-reported anxiety, fear, pain and nausea-vomiting levels, time to first mobilization and flatus. The outcomes were analyzed using an independent groups t-test, a Mann-Whitney U test, and changes over repeated measurements were analyzed using Generalized Estimating Equations, including group, time, and group-time interaction.
Results:
Compliance with most mERAS interventions exceeded 85%; however, participation in activities including using a remote-controlled car, watching educational animations remained below 60%. Postoperative hospital stay was statistically significantly shorter in the intervention group (MD = -9.84 h; 95% CI: -15.53 to -4.15; p = 0,001). The times of first postoperative mobilization (MD = - 4.63 h; 95% CI: - 5.80 to -3.46; p < 0.001), and first flatus (MD = -8.31 h; 95% CI = -11.46 to -5.16; p = 0,001), were shorter in the intervention group. In the multivariate regression analysis, care based on the mERAS protocol was independently associated with a decreased risk of prolonged hospital stay (β = -8.174; 95% CI: -13.958 to -2.750; p = 0.004).
Conclusion:
The nurse-led mERAS protocol is effective perioperative care model. This protocol has enhanced recovery in children undergoing appendectomy and improved important patient outcomes such as pain, anxiety, and thirst. The findings support the integration of structured, nurse-led protocols into routine pediatric surgical care to optimize patient recovery.
Registration:
The trial registered in the Clinicaltrial.gov (NCT05962320). The first recruitment was conducted October 2023.
