Masood Ayesha, Viqar Sana, Zia Naeem, Ghani Muhammad Usman
General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Surgery, Benazir Bhutto Hospital, Rawalpindi, PAK.
Cureus. 2021 Jan 7;13(1):e12553. doi: 10.7759/cureus.12553.
Introduction Enhanced recovery after surgery (ERAS) protocols have been widely studied in elective abdominal surgeries with promising outcomes. However, the use of these protocols in emergency abdominal surgeries has not been widely investigated. This study aimed to evaluate ERAS application outcomes via early oral feeding compared to regular postoperative care in patients undergoing perforated duodenal ulcer repairs in emergency abdominal surgeries. Materials and methods We conducted a randomized controlled trial at the Surgical Unit 1 Benazir Bhutto Hospital from August 2018 to December 2019. A total of 42 patients presenting to the emergency department with peritonitis secondary to suspected perforated duodenal ulcer were included in the study. Patients were randomly assigned into two groups. Group A patients followed an ERAS protocol for early oral feeding, and Group B received regular postoperative care (i.e., delayed oral feeding). Our primary outcomes were the length of hospital stay, duodenal repair site leak, the severity of pain (via the visual analog scale), and postoperative ileus duration. Results were analyzed via IBM Statistical Product and Service Solutions (SPSS) Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). and chi-square and independent t-tests were applied. Results Patients who received early oral feeding (Group A) showed a shorter length of hospital stay, lower pain scores, and shorter postoperative ileus duration than patients in the traditional postoperative care group. Also, we noted no duodenal repair site leak in the early oral feeding group. The differences between the two groups were statistically significant (P<0.05). Conclusions Based on our results, ERAS protocols that promote early oral feeding can be applied in patients undergoing emergency abdominal surgery for perforated duodenal repair. Early oral feeding in emergency surgery patients can reduce the patient burden on hospitals. In addition, early oral feeding can promote better outcomes and reduced economic burden for patients. Keywords: Perforated duodenal ulcer, ERAS protocol, randomized controlled trial, duodenal repair site leak, length of hospital stay, VAS score, postoperative ileus.
引言 手术加速康复（ERAS）方案已在择期腹部手术中得到广泛研究，取得了令人满意的结果。然而，这些方案在急诊腹部手术中的应用尚未得到广泛研究。本研究旨在评估在急诊腹部手术中接受十二指肠溃疡穿孔修补术的患者，与常规术后护理相比，通过早期口服喂养应用ERAS的效果。材料与方法 我们于2018年8月至2019年12月在贝娜齐尔·布托医院第一外科病房进行了一项随机对照试验。共有42例因疑似十二指肠溃疡穿孔继发腹膜炎而到急诊科就诊的患者纳入本研究。患者被随机分为两组。A组患者遵循ERAS方案进行早期口服喂养，B组接受常规术后护理（即延迟口服喂养）。我们的主要结局指标为住院时间、十二指肠修复部位渗漏、疼痛严重程度（通过视觉模拟量表）和术后肠梗阻持续时间。结果通过IBM统计产品与服务解决方案（SPSS）Windows版统计软件20.0（纽约州阿蒙克：IBM公司）进行分析，并应用卡方检验和独立样本t检验。结果 与传统术后护理组患者相比，接受早期口服喂养的患者（A组）住院时间更短、疼痛评分更低、术后肠梗阻持续时间更短。此外，我们注意到早期口服喂养组未出现十二指肠修复部位渗漏。两组之间的差异具有统计学意义（P<0.05）。结论 根据我们的结果，促进早期口服喂养的ERAS方案可应用于接受急诊腹部手术进行十二指肠穿孔修补的患者。急诊手术患者早期口服喂养可减轻医院的患者负担。此外，早期口服喂养可促进患者获得更好的结局并减轻经济负担。关键词：十二指肠溃疡穿孔；ERAS方案；随机对照试验；十二指肠修复部位渗漏；住院时间；VAS评分；术后肠梗阻
