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

OBJECTIVE The present study aimed to evaluate the safety, efficacy, and feasibility of adapted ERAS protocols in emergency abdominal operations. BACKGROUND Emergency abdominal surgeries comprise a majority of emergencies and are high-risk procedures owing to their urgency and limited time for optimization of co-morbidities. Enhanced Recovery After Surgery(ERAS) protocols in an adapted form can potentially improve patient outcomes in emergency settings. METHODS This open-labeled, single-center, superiority, randomized controlled trial was conducted over 18 months. Patients with acute abdomen planned for surgery were randomized pre-operatively to adapted ERAS or standard care group in a 1:1 ratio. Patients with refractory shock, coagulopathy, age <18 years, American Society of Anaesthesiologists (ASA) class 4E, polytrauma, and pregnancy were excluded. The primary outcome was the length of hospitalization (LOH) while the secondary outcomes were functional recovery parameters,30-day morbidity and mortality. RESULTS Fifty patients were analyzed in each group, showing comparable demographic and clinicopathological characteristics. The adapted ERAS group had 6 days shorter LOH [10(7-17) vs. 16(11-22), p<0.001)], early functional recovery in terms of reduction in time (days) to first flatus(2.48 vs 3.14, p=0.001), start solid diet(3 vs 4, p=0.035), first stool(4 vs. 5, p=0.001) and reduction in pulmonary complications (RR 0.47, p= 0.011). Post-operative nausea, vomiting(RR 0.62, p=0.372), surgical site infections(RR 0.73, p=0.067) and urinary tract infections(RR 0.25, p=0.092) were similar in both groups. CONCLUSION Adapted ERAS pathways are safe, feasible, and reduce the LOH in patients undergoing emergency abdominal operations. TRIAL REGISTRATION CTRI/2021/05/033558 registered at clinical trials registry-India https://ctri.nic.in/Clinicaltrials/login.php.