The Application of Enhanced Recovery After Surgery Protocols in Patients With Perforated Duodenal Ulcer

Abstract

BackgroundEnhanced recovery after surgery (ERAS) protocols are nowadays considered the standard of care for various elective surgical procedures. However, its utilization remains low in tier-two and tier-three cities of India, and there exists a significant variation in the practice. In the present study, we have investigated the safety and feasibility of these protocols or pathways in emergency surgery for perforated duodenal ulcer disease. MethodsA total of 41 patients with perforated duodenal ulcers were randomly divided into two groups. All the patients across the study were treated surgically with the open Graham patch repair technique. Patients in group A were managed with ERAS protocols, while patients in group B were managed with conventional peri-operative practices. A comparison was established between the two groups in terms of the duration of hospital stay and other postoperative parameters. ResultsThe study was conducted on 41 patients who presented during the study period. Group A patients (n=19) were managed with standard protocols, and group B patients (n=22) were managed with conventional standard protocols. As compared to the standard care group, patients in the ERAS group showed quicker postoperative recovery and lesser complications. The need for nasogastric (NG) tube reinsertion, postoperative pain, postoperative ileus, and surgical site infections (SSI) were all significantly lower in the patients of the ERAS group. A significant reduction in the length of hospital stay (LOHS) was found in the ERAS group when compared to the standard care group (relative risk {RR}=61.2; p=0.000). ConclusionsThe application of ERAS protocols with certain modifications in the management of perforated duodenal ulcers yields significant outcomes in terms of reduced duration of hospital stay and fewer postoperative complications in a selected subgroup of patients. However, the application of ERAS pathways in an emergency setup needs to be further evaluated to develop standardized protocols for a surgical emergency group of patients.

Fast‐track recovery after surgery for perforated peptic ulcer safely shortens hospital stay: A systematic review and meta‐analysis of six randomized controlled trials and 356 patients

“…Finally, six studies with a total cohort of 356 patients were included. [12][13][14][15][16][17] No patients were lost to follow-up. List of included studies and evidence grading as well as risk of bias are shown in Table 1.…”

“…Finally, six studies with a total cohort of 356 patients were included 12–17 . No patients were lost to follow‐up.…”

“…10,11 There are several randomized controlled trials (RCTs) supporting fast-track recovery specifically after surgery for perforated peptic ulcers, but the individual cohorts are small. [12][13][14][15][16][17] The aim of this study was to evaluate fast-track recovery in this diagnosis-specific context in a larger sample focusing on the length of hospital stay and risk of complications.…”

“…Recent reviews have evaluated fast‐track recovery for emergency abdominal surgery as well, but they are limited by the heterogeneity of the included cohorts, making the results difficult to implement clinically 10,11 . There are several randomized controlled trials (RCTs) supporting fast‐track recovery specifically after surgery for perforated peptic ulcers, but the individual cohorts are small 12–17 . The aim of this study was to evaluate fast‐track recovery in this diagnosis‐specific context in a larger sample focusing on the length of hospital stay and risk of complications.…”

Enhanced perioperative care in emergency general surgery: the WSES position paper

“…Currently, available studies about enhanced perioperative care in emergency general surgery are few, sparse and very heterogeneous. In addition, the perioperative care protocol derived from the elective ERAS protocol but with several and substantial differences [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Tables 1 and 2 show in detail the protocols adopted in the evaluated studies.…”