Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Department of Anaesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
World J Surg. 2023 Dec;47(12):2990-2999. doi: 10.1007/s00268-023-07176-1. Epub 2023 Sep 23.
Enhanced Recovery After Surgery (ERAS) is a multimodal approach with promising results in improving patient outcome. Only recently, is evidence emerging highlighting how similar principles of care can be applied to patients undergoing emergency abdominal surgery.
A randomized controlled trial was conducted from November 2021 to April 2022 at PGIMER Chandigarh, which is a leading tertiary care hospital in northern India. 60 patients with acute intestinal obstruction requiring emergency laparotomy were randomized and assigned to ERAS or Non-ERAS group. ERAS protocol with some modifications was applied. Primary endpoints were post-operative hospital stay. Secondary end points were morbidity, 30-day readmission and mortality rate. Data analysis was done using SPSS 22.0. Independent t test or Mann-Whitney test and Chi-square or Fisher-exact test were used for analysis.
A significant 3-day reduction in hospital stay was observed in ERAS compared to non-ERAS group (median (interquartile range) 5.50 (4.75-8.25) vs 8.0 (6.0-11.0) p = 0.003) with no difference in 30-day readmission rate, mortality rate and complication rate (according to Clavien-Dindo classification). ERAS group was associated with early recovery of gastrointestinal functions including time to first passage of flatus (p < 0.001), stools (p = 0.014), early ambulation (p < 0.001), time to first fluid diet (p < 0.001), solid diet (p = 0.001) and reduced nasogastric tube reinsertion rates (p = 0.01) despite its early removal.
ERAS with some modifications can be applied in patients with intestinal obstruction. Thus, we can expedite post-operative recovery and early regain of gastrointestinal function with decreased hospital stay, comparable morbidity and mortality. Further studies are needed to assess ERAS role in emergency gastrointestinal surgeries. Trial registration Ctri.gov Identifier: CTRI/2022/04/042156.
加速康复外科（ERAS）是一种多模式方法，在改善患者预后方面取得了有希望的结果。直到最近，才出现证据表明，类似的护理原则也可以应用于接受紧急腹部手术的患者。
一项随机对照试验于 2021 年 11 月至 2022 年 4 月在印度北部的一家领先的三级保健医院 PGIMER 昌迪加尔进行。60 名因急性肠梗阻需要紧急剖腹手术的患者被随机分配到 ERAS 或非 ERAS 组。应用了 ERAS 方案，并进行了一些修改。主要终点是术后住院时间。次要终点是发病率、30 天再入院率和死亡率。数据分析使用 SPSS 22.0 进行。使用独立 t 检验或曼-惠特尼检验和卡方或 Fisher 精确检验进行分析。
与非 ERAS 组相比，ERAS 组的住院时间显著缩短 3 天（中位数（四分位距）5.50（4.75-8.25）比 8.0（6.0-11.0），p=0.003），30 天再入院率、死亡率和并发症率（根据 Clavien-Dindo 分类）无差异。ERAS 组胃肠道功能恢复较早，包括首次排气时间（p<0.001）、排便时间（p=0.014）、早期下床活动时间（p<0.001）、首次经口进食时间（p<0.001）、固体饮食时间（p=0.001）和减少鼻胃管再插入率（p=0.01），尽管其早期移除。
对肠梗阻患者进行适当修改的 ERAS 可以应用。因此，我们可以加快术后恢复和胃肠道功能的早期恢复，缩短住院时间，降低发病率和死亡率。需要进一步研究来评估 ERAS 在紧急胃肠道手术中的作用。试验注册 Ctri.gov 标识符：CTRI/2022/04/042156。
