Safety and Feasibility of Enhanced Recovery after Surgery (ERAS) Protocol in Patients Undergoing Stoma Closure

Abstract

Enhanced Recovery after Surgery (ERAS) protocol is a multimodal approach which includes variety of pre-, intra-, and postoperative components to minimize surgical trauma, reduce complications, and decrease hospital length of stay, while expediting accelerated recovery following elective procedures. This study aimed to compare the postoperative outcome using the conventional management versus ERAS protocol in patients undergoing stoma (ileostomy and colostomy) closure. A prospective, comparative, longitudinal study was conducted using census technique in 30 patients admitted to surgery department, between January 2018 and March 2019 for ileostomy or colostomy closure. The postoperative length of hospital stay, readmission, morbidity, and mortality were compared between two groups of participants undergoing stoma closure either by ERAS (group A, n = 15) or by conventional care (group B, n = 15) protocol. Chi-square test and Student t test were used for analysis. The mean postoperative length of hospital stay was shorter in ERAS group compared with conventional care group (1.5 vs. 6.5 days, p < 0.001). However, no statistically significant differences were reported in terms of readmission and morbidity between the two groups. One major morbidity (anastomotic leak) in conventional group was reported. There was no 30-day mortality in either group. In comparison with the conventional care group, the application of ERAS protocol in the stoma closure resulted in decreased postoperative length of hospital stay. No differences were observed for readmission, re-exploration, and other postoperative morbidities between the two groups.

Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS)

“…All studies included general surgical patients, except for Elayat et al [ 32 ], which included neurosurgical patients. Two studies [ 29 , 31 ] exclusively included stoma reversal procedures. Only two studies [ 28 , 31 ] were RCTs.…”

“…diabetes or cardiac disease) were excluded from all studies apart from Shetiwy et al [ 28 ] and Gopakumar et al [ 30 ] . Additionally, Kurmi [ 29 ] required patients to have a body mass index (BMI) <30, to live within two hours of the hospital, and to have access to a phone, transport, and a responsible next of kin staying in the hospital with them for at least 24 hours ( Table 1 ).…”

“…Most studies reported mortality as a secondary outcome, with low rates across all studies ( Table 3 ). Kurmi et al [ 29 ] were only ones to use a standardised definition of complications (Clavien-Dindo), preventing meaningful grouping of this outcome in meta-analysis. Length of follow-up was 30 days for all studies, except for Gopakumar et al [ 30 ], for whom it was three months, and Pirzada et al [ 31 ], who did not report a follow-up length of time.…”

“…Three patients had a pulmonary embolism (PE) in the control group in Shetiwy et al [ 28 ], with two resulting in death. Other adverse events included two anastomotic leaks (one in each group) in Nanavati et al [ 27 ] and one anastomotic leak in the control group for Kurmi et al [ 29 ].…”

“…However, the prediction interval was large (95% CI = -7.85, 3.48) and I 2 was 94%, indicating substantial between-study heterogeneity [ 35 ]. A sensitivity analysis [ 36 ] found no outliers and there was no marked asymmetry in the funnel plot analysis (Figure S1 in the Online Supplementary Document ), although Kurmi et al [ 29 ] had a high effect size and high standard error. A sensitivity analysis excluding Elayat et al [ 32 ] and including only general surgical patients showed similar results, with a standardised mean difference of -2.69 (95% CI = -4.86, -0.52; P < 0 .…”