Enhanced Recovery After Surgery Versus Conventional Care in Patients After Urgent Laparotomy: A Prospective Cohort Study.

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols, though extensively accepted in prearranged procedures, remain underutilized in emergency settings such as emergency laparotomy (EL), which carries morbidity and mortality rates. This study evaluated the feasibility, safety, and clinical performance of ERAS protocols versus conventional care in participants requiring emergency laparotomy.

Methods: This prospective cohort study involved 72 individuals with abdominal pathology requiring EL. The participants in this study were equally categorized into two cohorts (n = 36): Group I, designated as the urgent (ERAS) group, and Group II, referred to as the urgent standard care group. Our hospital's general surgery department has two gastrointestinal tract (GIT) units. One uses the ERAS method, whereas the other uses the conventional method. Patients from both units were equally included.

Results: The ERAS group demonstrated a markedly quicker improvement reflected in days to first bowel movement (p = 0.005), first resumption of fluids (p < 0.001), initiation of a soft diet (p < 0.001), and transition to a solid diet (p < 0.001). Pain relief was markedly better in the ERAS group, with an average pain score of 3.14 ± 1.02 compared to 4.0 ± 1.47 in the standard care group (p = 0.012). Average inpatient stay in the ERAS group was (4.64 ± 1.23) days, whereas it was (8.96 ± 1.87) days in the standard care group (p > 0.001). Additionally, there was a meaningful decrease in the incidence of postoperative paralytic ileus in the ERAS group (p = 0.035). No meaningful differences between the cohorts were observed in mortality rates, readmission, or reoperation rates.

Conclusions: ERAS protocols demonstrate significant clinical benefits in EL patients, substantially reducing inpatient stay and postoperative complications while maintaining safety profiles.