EXAMINING THE IMPACT OF ENHANCED RECOVERY AFTER SURGERY PROTOCOLS ON POSTOPERATIVE RECOVERY IN GENERAL SURGICAL PATIENTS

Main Article Content

Muhammad Daud
Muhammad Mubassir
Sikandar Khan
Muhammad Uzair
Muhammad Salman
Musawer Ibrar
Muhammad Bilal Khan
Mohsin Hassan Khan

Keywords

General Surgery, Postoperative Recovery, Enhanced Recovery after Surgery (ERAS), Length of Hospital Stay

Abstract

Background: General surgery involves several procedures; each carries its own limitations. Traditional perioperative management protocol includes prolonged fasting, delayed mobility and narcotic painkillers, hence prolonged hospital stay.


Objective: To examine the effects of ERAS protocols on the process of recovering after surgery in a group of patients undergoing general surgical procedures.


Methodology: A descriptive analysis of 75 adult elective general surgery patients was studied. Patients were recruited from General Surgery unit C Lady Reading Hospital, Peshawar - Pakistan from December 1st, 2022, to November 30th, 2023. Participants were arbitrarily assigned to two groups A and B. Both groups were matched for age and gender. Patients in group A (control group) received standard perioperative treatment. Patients in group B (ERAS/study Group) received surgical care that included preoperative therapy, pain management, early mobilization and oral feeding.


Results: The study included 75 patients: 37 in the control group and 38 in the ERAS group. Male participants made up 56.8% of the control group and 60.5% of the ERAS group. The ERAS group had significantly shorter hospital stays versus control (3.2 days vs 4.8 days, p<0.001), lower bowel function recovery time (24.5 hours versus 36.5 hours, p<0.001) and significantly lower postoperative complication rate than the control group (13.2% vs 32.4%, p value <0.001).


Conclusion: ERAS method for patients undergoing elective general surgery has better post-operative recovery with decreased postoperative complications than traditional recovery management approach.

Abstract 266 | pdf Downloads 47

References

1. Mithany RH, Daniel N, Shahid MH, Aslam S, Abdelmaseeh M, Gerges F, et al. Revolutionizing Surgical Care: The Power of Enhanced Recovery After Surgery (ERAS). Cureus. 2023 Nov 14;15(11). DOI: 10.7759/cureus.48795.
2. McKechnie T, Parpia S, Bhandari M, Dionne JC, Eskicioglu C. Enhanced Recovery After Surgery (ERAS) protocols following emergency intra-abdominal surgery: A systematic review and meta-analysis protocol. PLoS One. 2023 Sep 8;18(9):e0291140. doi.org/10.1371/journal.pone.0291140.
3. Garmpis N, Dimitroulis D, Garmpi A, Diamantis E, Spartalis E, Schizas D, et al. Enhanced recovery after surgery: is it time to change our strategy regarding laparoscopic colectomy?. In vivo. 2019 May 1;33(3):669-74. doi.org/10.21873/invivo.11525.
4. Chestovich PJ, Lin AY, Yoo J. Fast-track pathways in colorectal surgery. Surgical Clinics. 2013 Feb 1;93(1):21-32. DOI:https://doi.org/10.1016/j.suc.2012.09.003.
5. Senturk JC, Kristo G, Gold J, Bleday R, Whang E. The development of enhanced recovery after surgery across surgical specialties. Journal of Laparoendoscopic & advanced surgical techniques. 2017 Sep 1;27(9):863-70. doi.org/10.1089/lap.2017.0317.
6. Scott JW, Olufajo OA, Brat GA, Rose JA, Zogg CK, Haider AH, et al. Use of national burden to define operative emergency general surgery. JAMA surgery. 2016 Jun 1;151(6):e160480-. doi:10.1001/jamasurg.2016.0480.
7. Rodrigues G, Ravi C, Prabhu R. Fast-track surgery: A new concept of perioperative management of surgical patients. Journal of Health Specialties. 2013 Sep 1;1(3):114-. link.gale.com/apps/doc/A348486585.
8. Dipokromo A, Sherman DW, Lago Sr C. Preoperative Education Regarding the Enhanced Recovery After Surgery (ERAS) Guideline for Colorectal Surgical Patients: A Quality Improvement Project. https://digitalcommons.fiu.edu/cnhs-studentprojects/163.
9. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA surgery. 2017 Mar 1;152(3):292-8. doi:10.1001/jamasurg.2016.4952.
10. Feldheiser A, Aziz O, Baldini G, Cox BP, Fearon KC, Feldman LS, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiologica Scandinavica. 2016 Mar;60(3):289-334. doi.org/10.1111/aas.12651.
11. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clinical nutrition. 2012 Dec 1;31(6):783-800. doi.org/10.1016/j.clnu.2012.08.013.
12. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database of Systematic Reviews. 2011(2). doi.org/10.1002/14651858.CD007635.pub2.
13. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clinical nutrition. 2010 Aug 1;29(4):434-40. doi.org/10.1016/j.clnu.2010.01.004.
14. Spanjersberg, WR, van Sambeeck JDP, Bremers A. Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc. 2015; 29:3443–3453. https://doi.org/10.1007/s00464-015-4148-3
15. Greco M, Capretti G, Beretta L. Enhanced Recovery Program in Colorectal Surgery: A Meta-analysis of Randomized Controlled Trials. World J Surg. 2014; 38: 1531–1541. https://doi.org/10.1007/s00268-013-2416-8.
16. Gustafsson UO, Scott MJ, Schwenk W. Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg. 2013; 37: 259–284. https://doi.org/10.1007/s00268-012-1772-0s

Most read articles by the same author(s)