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Outcome of Enhanced Recovery After Surgery Protocols in Patients Undergoing Small Bowel Surgery.

ABSTRACT: Background and objective Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways to help patients achieve early recovery after surgical procedures. However, no evidence could be found about its role in patients undergoing small bowel surgery. This study's objective was to determine the outcome of applying ERAS protocols in patients undergoing small bowel surgery. Materials and methods This study was a descriptive case series conducted in the Department of Surgery at Services Hospital in Lahore, Pakistan, from September 2017 to August 2019. One hundred forty patients who underwent small bowel resection anastomosis were subjected to ERAS protocols. Written informed consent was received from all patients. Results The mean age of the patients was 34.1 ± 7.1 years. There were 101 (72.1%) men and 39 (27.9%) women in the study sample. The mean length of postoperative hospital stay was 4.59 ± 1.69 days. Postoperative wound infection occurred in six (4.3%) patients, while anastomotic leakage was observed in 12 (8.6%) patients. Five (3.6%) patients died within 30 days of surgery. A significantly increased length of postoperative hospital stay was associated with anastomotic leakage (9.08 ± 1.975 vs. 4.16 ± 0.83 days; p=0.00). Similarly, the frequency of wound infection (41.7% vs. 0.8%; p=0.00) and 30-day patient mortality (41.7% vs. 0%; p=0.00) was also significantly higher among those patients who acquired anastomotic leakage. Conclusion ERAS protocols were associated with a significant reduction in length of hospital stay of the patients undergoing small bowel surgery without any significant increase is anastomotic leakage, wound infection or mortality. Furthermore, anastomotic leakage occurred in the patients was significantly associated with a longer hospital stay, wound infection, and 30-day mortality. Therefore, ERAS protocols can be safely applied to small bowel surgery.

SUBMITTER: Ghufran S

PROVIDER: S-EPMC7676946 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Outcome of Enhanced Recovery After Surgery Protocols in Patients Undergoing Small Bowel Surgery.

Ghufran Samar S Janjua Atif A AA Chaudary Salman M SM Munawwar Fasiha F Hassan Muhammad M Changazi Shabbar H SH

Cureus 20201021 10

Background and objective Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways to help patients achieve early recovery after surgical procedures. However, no evidence could be found about its role in patients undergoing small bowel surgery. This study's objective was to determine the outcome of applying ERAS protocols in patients undergoing small bowel surgery. Materials and methods This study was a descriptive case series conducted in the Department of Surg ...[more]

PMID: 33224667

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Project description:ObjectiveTo compare post-operative length of stay and complication rates of matched obese and non-obese patients in an enhanced recovery (ERAS) program after open gynecologic cancer surgery.MethodsWe performed an observational cohort study of patients (n=1225) undergoing open surgery from November 2014 to November 2018 at a tertiary cancer center. Patients undergoing multidisciplinary procedures, non-oncologic surgery, or procedures in addition to abdominal surgery were excluded (n=190). Obese and non-obese patients were matched by date, age, disease status, and surgical complexity. The primary outcome was post-operative length of stay. Secondary outcomes included 30-day peri-operative complications, re-operation, re-admission, opioid use, and program compliance.ResultsAfter matching, 696 patients (348 obese, 348 non-obese) with median age of 57 years (IQR 48-66) were analyzed. Obese patients had a longer median procedure time (218 min vs 192.5 min, p<0.001) and greater median estimated blood loss (300 mL vs 200 mL, p<0.001). Median (IQR) post-operative length of stay was the same for obese and non-obese patients: 3 days (IQR 2-4). Obese and non-obese patients had similar rates of grade III-IV complications (10.9% and 6.6%, respectively, p=0.06), re-operation (2.3% and 1.4%, respectively, p=0.58), and re-admission (11.8% and 8.0%, respectively, p=0.13). Grade I-II complications were more common among obese patients (62.4% vs 48.3%, p<0.001) because they had more wound complications (17.8% vs 4.9%, p<0.001). Obese patients received more opioids both during surgery (morphine equivalent dose 57.25 mg (IQR 35-72.5) vs 50 mg (IQR 25-622.5), p=0.003) and after surgery (morphine equivalent daily dose 45 mg/day (IQR 10-96.2) vs 29.37 mg/day (IQR 7.5-70), p=0.01). Obese and non-obese patients had similar ERAS program compliance (70.1% and 69.8%, respectively, p=0.32).ConclusionsNeither post-operative length of stay nor the rate of serious complications differed significantly despite longer surgeries, greater blood loss, and more opioid use among obese patients. An ERAS program was safe, effective, and feasible for obese patients with suspected gynecologic cancer.

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Outcome of Enhanced Recovery After Surgery Protocols in Patients Undergoing Small Bowel Surgery.

Publications

Outcome of Enhanced Recovery After Surgery Protocols in Patients Undergoing Small Bowel Surgery.

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