MTP2.06 Comparison of adapted Enhanced Recovery After Surgery (ERAS) pathway versus standard care in patients undergoing emergency abdominal surgery – A randomized controlled trial

Aims This study aimed to evaluate the safety, feasibility and efficacy of adapted ERAS protocols in emergency abdominal surgery. Methods This was a single-center, open-labeled, superiority, randomized controlled trial carried out in a tertiary care hospital. All consecutive patients over 18 years of age with acute abdomen planned for emergency abdominal surgery based on clinical and adjunctive investigations were included. Patients with refractory shock, coagulopathy, age <18 years, ASA class 4E, polytrauma, and pregnancy were excluded. Eligible patients were randomized pre-operatively to either the standard care or adapted ERAS group. The primary outcome was to compare the length of hospitalization (LOH). The secondary outcomes were to compare functional recovery parameters,30-day morbidity, and mortality between the two groups Results This study included 49 patients in adapted ERAS and 47 in the standard care group. Both the groups were comparable in terms of demographic and clinicopathological characteristics. The adapted ERAS group had 6 days shorter LOH (median-10 days (7-17) vs. median 16 days (11-22), p<0.001), showed an early functional recovery in terms of reduction in time (days) to first flatus (2.48 vs 3.14, p=0.001), solid diet (3 vs 4, p=0.035) and first stool (4 vs. 5, p=0.001). Additionally, there was a reduction in pulmonary complications (RR 0.47, p= 0.011) with similar rates of other postoperative complications like postoperative nausea, vomiting, surgical site infections, and urinary tract infections. Conclusion Adapted ERAS pathways are safe and feasible in patients undergoing emergency abdominal surgery, with a considerable reduction in LOH, and without increasing complications.