IMPACT OF AN ENHANCED RECOVERY AFTER SURGERY PROTOCOL ON POSTOPERATIVE OUTCOMES FOLLOWING ELECTIVE GASTROINTESTINAL SURGERY: A COMPARATIVE STUDY

Abstract

Objective:

To analyze the postoperative complications and recovery outcomes for an enhanced recovery after surgery (ERAS) pathway in comparison to traditional perioperative care for adults undergoing elective gastrointestinal surgery

Material & Methods:

This was a prospective comparative study conducted in Department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi. This study randomized a total of 120 patients, distributed equally between the two study groups. Grouping resulted in 60 patients per group. The main outcome of interest was postoperative complications of Clavien–Dindo Grade II or higher. These complications were analyzed for events that occurred in the first 30 days following surgery. The secondary outcomes were measured as length of stay, 30-day readmission, first flatus, first full meal, and the level of pain measured in the first 24 hours following surgery. The appropriate chi-square tests were utilized for the analysis of categorical outcomes. For continuous outcomes, independent samples t-tests were utilized.

Results:

Eight patients in the ERAS group had clinically relevant complications. In the conventional-care group, 23 patients had complications, which accounted for 38.3% of the group. The difference in complications between the two groups was significant, and a risk ratio of 0.35 (0.17–0.71) was calculated. The average length of stay following surgery was significantly shorter in the ERAS group, which stayed an average of 4.67 days, whereas the conventional-care group stayed an average of 8.45 days. Pain scores and times to first flatus and first full diet were also significantly better in the ERAS group. The 30-day readmission rate was also statistically not significant; however, the rate was lower for ERAS, which was 3.3%, compared to 8.3% in the conventional-care group, with a p-value of 0.243.

Conclusion:

Postoperative complications of a clinically relevant nature were significantly improved in the ERAS group compared to the conventional-care group. The ERAS pathway significantly improved the length of stay in the postoperative period and overall sped recovery for the remaining measured postoperative outcomes. Importantly, the ERAS group did not have an increase in 30-day readmissions compared to the conventional-care group.