Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT)

• Published in: The American journal of surgery 2024-12, Vol.238, p.115975, Article 115975
• Main Authors: Jain, Vibhu, Irrinki, Santhosh, Khare, Siddhant, Kurdia, Kailash Chand, Nagaraj, Sathish Subbiah, Sakaray, Yashwant Raj, Savlania, Ajay, Tandup, Cherring, Verma, Prerna, Kaman, Lileshwar
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Injuries - surgery; Adult; Analgesia; Catheters; Emergency medical services; Enhanced Recovery After Surgery; ERAS; Feasibility Studies; Female; Humans; Intestine; Laparotomy; Laparotomy - adverse effects; Length of Stay - statistics & numerical data; Male; Medical instruments; Middle Aged; Modified ERAS; Morbidity; Mortality; Narcotics; Patients; Population; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Principles; Prospective Studies; Recovery; Recovery (Medical); Recovery of Function; Statistical analysis; Surgery; Surgical site infections; Trauma; Treatment Outcome; Young Adult
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.115975

Enhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy. Prospective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 ​h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo). Fifty patients were randomized into ERAS(n ​= ​25) and conventional care(n ​= ​25) groups. Ninety-two percent of patients were young males, 58 ​% had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 ​%). ERAS group had a reduced median LOH(days) (6 versus 8, p ​= ​0.007), early recovery of bowel function(p ​= ​0.010) and shorter times for nasogastric tube(p ​= ​0.001), urinary catheter(p ​= ​0.007) and drain(p ​= ​0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p ​= ​0.009)]. ERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy. •The major aim of perioperative care-attenuate the surgical stress response.•ERAS is a method, not a rigid protocol.•Leads to reduced length of hospital stay without increased complication rates.•Widely accepted in the elective setup-paucity of studies in trauma patients.