ERAS protocol in emergency cases: A case series
Journal Title: Medpulse International Journal of Surgery - Year 2018, Vol 5, Issue 3
Abstract
Background: Enhanced recovery after surgery (ERAS) is a systematic approach to facilitate better state of patient for surgery and early recovery post surgery. ERAS protocol mainly focuses on modification of conventional perioperative modalities followed worldwide to reduce perioperative psychological and physical stress. This study was undertaken to evaluate the ERAS protocol in elective and emergency conditions. Aim: Clinical study of ERAS protocol in 50 cases of emergency appendectomy and 50 cases of elective open cholecystectomy. Material and Methods: 50 cases of emergency appendectomy and 50 cases of elective open cholecystectomy were studied. Of which 25 cases in each group followed ERAS protocol and remaining 25 cases followed conventional protocol. All cases of acute appendicitis and chronic cholelithiasis coming to surgery OPD were evaluated as per respective protocols. Results: In emergency appendectomy group : Pre operative fasting for patients following conventional protocols were 7.5 hrs ( for solids) and 6 hrs (for liquids) whereas for patients following ERAS protocols were 6.3 hrs (for solids) and 3.8 hrs (for liquids). Patients following ERAS protocols have significantly less time required for bowel movements and initiating soft diet. Patients following ERAS protocols have significantly less time required for mobilisation and also significantly less length of stay. In open cholecystectomy group: Pre operative fasting for patients following conventional protocols were 8 hrs ( for solids) and 6 hrs (for liquids) whereas for patients following ERAS protocols were 6 hrs (for solids) and 2 hrs (for liquids). Patients have significantly less time required for bowel movements and initiating soft diet after following ERAS protocols. However time required for complete mobilization was not statistically different. Patients following ERAS protocols have less length of stay. Rate of complications were not significantly different in both the groups except postoperative pain which was lower in patients following ERAS protocols group. Conclusion: ERAS or Fast track surgery is an idea that promotes early recovery after surgery by integrating modalities of therapy in preoperative, intraoperative and post operative phases. Early feeding is possible without any significant nausea and vomitting. Early mobilisation helps in faster recovery of patients. Patients following ERAS protocols have less hospitalization with no significant difference in morbidity. ERAS protocols is efficient and safe in both emergency and elective surgeries.
Authors and Affiliations
Shivmurti Khandalkar, Suresh Naik, Firoz Alam, Ashwini Panditrao
Keywords
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