Feasibility and effects of enhanced recovery vs. conventional care after emergency colon surgery for patients with left colon perforation

Abstract

The impact of an enhanced recovery after surgery (ERAS) programme in emergency colorectal surgery has not yet been reported. The objective of this study was to evaluate the feasibility and the results of patients included in an ERAS protocol following emergency colon surgery for left colon perforation. For this purpose, patients with a low to moderate risk of mortality, according to a Peritonitis Severity Score (PSS), and treated with an ERAS protocol (ERAS group) after emergency surgery for left colon perforation were compared for a period of 40 months (March 2014-June 2017) with a control group of patients treated with conventional care (CC group) during the 38 months prior to implementation of the new ERAS protocol (January 2011-February 2014). The main endpoint was 90-day postoperative morbidity according to the Clavien-Dindo classification. Secondary endpoints included length of postoperative hospital stay, 90-day readmission rate, protocol compliance and mortality. Fifty patients were included in the study, 29 in the ERAS group and 21 in the CC group. There were no significant differences between the groups in the demographic data or in the operative characteristics. A reduction in the incidence of postoperative complications (20.7% vs. 38%; p > 0.05) and in the postoperative hospital stay (7.7 + /-3.85 vs. 10.9 + /-5.6 days; p = 0.009) were observed in the ERAS group. The 90day readmission rate did not differ significantly between the two groups (2 vs. 1). No 90-day mortality was observed in either group. The ERAS group showed better results than the CC group in protocol compliance. We conclude that ERAS protocols are feasible and help to reduce morbidity and length of hospital stay without adversely affecting the rate of readmission or mortality.

Enhanced recovery after emergency surgery: A systematic review

“…Type Overall Assessment of the study Level of Evidence Yuanyuan Shang [5] RCT Acceptable 1++ M.N Chndan [8] RCT Acceptable 1++ J.C Wisley [7] Cohort Acceptable 2+ Lohisiriwat [6] Cohort High quality 2++ ARAA Fattah [16] RCT Acceptable 1++ X Vinas [9] Cohort Acceptable 2+ Mohsina [17] RCT High quality 2++ Shida [18] Cohort Acceptable 2+ Saurabh [19] RCT Acceptable 1+ Gonenc [20] RCT Acceptable 1+…”

“…Pre Intra Post Yuanyuan Shang [5] 5/7 5/6 4/6 M.N Chndan [8] 3/7 3/6 5/6 J.C Wisley [7] 4/7 5/6 5/6 Lohisiriwat [6] 1/7 6/6 5/6 ARAA Fattah [18] 2/3 4/4 2/3 X VINAS [9] 3/7 6/6 4/6 Mohsina [17] 5/7 4/6 5/6 Shida [18] 4/7 4/6 5/6 Saurabh [19] 5/7 4/6 4/6 Gonenc [20] 4/7 4/6 4/6 [5] 2018 356/483 Obstructed colorectal cancer 65.5 M.N Chndan [8] 2020 42/43 Perforated peptic ulcer 46.16 J.C Wisley [7] 2016 169/201 Abdominal surgery 68 Lohisiriwat [6] 2014 20/40 Colorectal surgery 59.8 ±13.2 ARAA Fattah [16] 2020 30/30 Abdominal surgery (pediatric) 6.6 Months X Vinas [9] 2020 29/21 Colon perforation 56 ± 2 Mohsina [17] 2016 50/49 Perforated duodenal ulcer 47.145±2.28 Shida [18] 2012 80/42 Obstructed colorectal cancer 68.25 Saurabh [19] 2020 35/35 Emergency small bowel surgery 44.37±5.6 Gonenc [20] 2014 21/26 Perforated peptic ulcer -…”

“…Length of hospitalization (days) Eras cc Yuanyuan Shang [5] 6(3-22) 9(7-27) P< 0.001 M.N chndan [8] 5.31±1.102 9.05±1.27 Mean difference 3.74 P< 0.0001 J.C wisley [7] 8 8 Lohisiriwat [6] 6.0±2.9 9.4±5.1 P< 0.002 Araa Fattah [16] 1.93±2.23 4.23±2.21 P< 0.001 X vinas [9] 7 9 Mohsina [17] 5.36±1.399.78±4.30 P< 0.0001 Shida [18] 7(7-8.75) 10(10-14.25) Interquartile range Saurabh [19] 8±0.38 10.83±0.42 Gonenc [20] 3.8±1.9 6.9±2.2 P=0.0001 P< 0.001 is considered significant…”

“…x.vinas [9] 2/29 (6.8%) 1/21 (4.7%) No 30 day mortality 6/29 (20.7%) 8/21 (38%) Clavien Dindo classification Mohsina [17] -No 30 day mortality SSI-10% 29% Pulmonary-4% 16% UTI-2% 18% Shida [18] 0% 2.5% 0% 2.5% 10% 15% GRADE 2 or more Saurabh [19] --SSI-37% 49% Deep SSI-6% 11% Pulmonary-3% 11% UTI-14% 23% Gonenc [20] -0/21…”

“…Yuanyuan [5] 0.7±0.5 (3.1±0.3) 0.8±0.5(3.1±0.4) 3.2±1.5(5.6±1.6) 2.5±1.5(3.5±1.4) -MN Chndan [8] 1.43±0. JC Wisley [7] 57%(66%) Placed longer than 2 days -63% (52%) On 4 th day -57% (40%) Within 48 PO hours Lohsiriwat [6] --3.4±1.75(5.5±2.4) 3.4±1.2(3.7±1.4) -ARAA Fattah [16] 86.7% (33%) Removed early -1.23±0.68(2.9±1.45) 1.43±0.86(1.83±1.02) Early removal in ERAS X Vinas [9] 79.3% (0%) Within 12 PO hours -79.3% (0%) Within 24 PO hours -42.3% (4.76%) Within 48 PO hours Mohsina [17] 1.22±0.42(3.37±0.97) 1.52±0.76(4.24±2.64) 2.64±1.08(4.24±2.64) 3.52±0.79(5.78±1.26) 1.38±1.09(5.04±2.12) Shida [18] -----Saurabh [19] 1.68±0. [20] -----PO: post operative…”