Experience of Using Enhanced Postoperative Recovery Program in the Treatment of Pelvioperitonitis

Abstract

Purpose: This article describes the experience of using the Enhanced Recovery After Surgery (ERAS) program in the treatment of female patients with pelvioperitonitis in a gynecological in-patient department. Materials and Methods: We examined 60 female patients who were divided into the main and comparison groups. The groups were comparable in terms of age, marital status, education, and place of residence. In addition to the standard approaches in the treatment of pelvioperitonitis, 30 patients of the main group were treated using some elements of the concept of enhanced recovery, such as detailed preoperative counseling about future treatment, non-use of premedication, control of hypothermia during and after surgery, prevention of dyspeptic disorders in postoperative period, avoiding narcotic analgesics, early enteral nutrition and mobilization. In the comparison group, which also included 30 patients, the treatment of pelvioperitonitis was carried out in strict accordance with the standard scheme - surgery, balanced infusion therapy, symptomatic treatment. Results: At the same time, the pain level by the visual analogue scale (VAS) averaged 6.11 ± 0.34 after 2, 4 and 8 hours in women from the comparison group. Vomiting was registered in 3 (10.0%) patients from the main group on the day 1 of the postoperative period. Whereas 7 (23.3%) patients from the comparison group had vomiting on the day 1 of the postoperative period. The absence of active motility and passage of flatus, an increase in hypoproteinemia, hypoalbuminemia, and an increase in the level of leukocytosis in both groups showed the severity of the systemic inflammatory response. However, by the end of the day 2 of the postoperative period, the improvement in biochemical parameters was registered as a sign of a positive change in the patients’ general condition. LII decreased by 1.5 times by the day 5 in the comparison group; but in the main group it decreased by 2.3 times. First active peristaltic noises were auscultated and first passage of flatus were noted on average after 20.33 ± 1.02 hours in the main group, but in the comparison group - after 40.28 ± 0.81 hours. In addition to that, the need for pharmacological intestinal stimulation was 2.5 times higher in patients from the comparison group than in patients from the main group. Postoperative purulent inflammation of the wound was registered in 9 (30.0%) women from the control group. However, only 2 (6.7%) women from the main group had one of the above mentioned disorders. The absolute risk reduction is 15% and NNT = 7. The average hospital stay for patients from the main group was 6.15 ± 0.25 days, and 8.64 ± 0.38 days for women from the comparison group. Conclusion: The results obtained during the study prove the effectiveness of the concept of enhanced recovery in the treatment of pelvioperitonitis.