ERAS Vs. Conventional Postoperative Care in Major Abdominal Surgery – Effects on Hospital Stay and Complications
Keywords:
ERAS, Conventional Postoperative Care, Surgery, Recovery, postoperative complicationsAbstract
Background: Enhanced Recovery After Surgery (ERAS) protocols are multimodal, evidence-based pathways designed to optimize perioperative care and accelerate recovery in surgical patients. Conventional postoperative care, characterized by prolonged fasting and delayed mobilization, may contribute to longer hospital stays and higher complication rates. This study compares ERAS protocols with conventional care in major abdominal surgery, focusing on hospital length of stay (LOS) and postoperative complications.
Methods: A prospective comparative study was conducted at a tertiary care hospital involving 100 patients undergoing elective major abdominal surgeries (e.g., colectomies, gastrectomies). Patients were allocated into ERAS (n=50) or conventional care (n=50) groups. The ERAS protocol included preoperative carbohydrate loading, early oral intake, multimodal analgesia, and enforced mobilization. Conventional care involved traditional practices like prolonged fasting and opioid-based pain control. Primary outcomes were LOS and complication rates, analyzed using statistical methods including multivariate regression.
Results: The ERAS group had a significantly shorter median LOS (5 vs. 8 days, p<0.001) and lower overall complication rates (16% vs. 36%, p=0.02), with ileus being notably reduced (4% vs. 12%, p=0.04). Time to first oral intake (12.4 vs. 48.6 hours, p<0.001) and ambulation (10.5 vs. 36.2 hours, p<0.001) was shorter in the ERAS group. Readmission rates were comparable (6% vs. 10%, p=0.47). High ERAS compliance (>85%) correlated with better outcomes. Multivariate analysis confirmed ERAS as an independent predictor of reduced LOS (OR: 0.32, p<0.001).
Conclusion: ERAS protocols significantly reduce hospital stay and postoperative complications in major abdominal surgery without increasing readmission rates. These findings support the adoption of ERAS as a standard of care, emphasizing early mobilization, nutritional support, and multimodal analgesia. Future research should focus on broader implementation and cost-benefit analysis.
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Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961-9. doi:10.1001/archsurg.2009.170.
Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189-98. doi:10.1097/SLA.0b013e31817f2c1a.
Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr. 2012;31(6):783-800. doi:10.1016/j.clnu.2012.08.013.
Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(4):434-40. doi:10.1016/j.clnu.2010.01.004.
Greco M, Capretti G, Beretta L, et al. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38(6):1531-41. doi:10.1007/s00268-013-2416-8.
Zhuang CL, Ye XZ, Zhang CJ, et al. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56(5):667-78. doi:10.1097/DCR.0b013e3182812842.
Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R, et al. Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) study. JAMA Surg. 2019;154(8):725-36. doi:10.1001/jamasurg.2019.0995.
Rollins KE, Lobo DN. Intraoperative goal-directed fluid therapy in elective major abdominal surgery: a meta-analysis of randomized controlled trials. Ann Surg. 2016;263(3):465-76. doi:10.1097/SLA.0000000000001366.
Stone AB, Grant MC, Pio Roda C, et al. Implementation costs of an enhanced recovery after surgery program in the United States: a financial model and sensitivity analysis based on experiences at a tertiary academic medical center. J Am Coll Surg. 2016;222(3):219-25. doi:10.1016/j.jamcollsurg.2015.11.021.
Visioni A, Shah R, Gabriel E, et al. Enhanced recovery after surgery for noncolorectal surgery?: a systematic review and meta-analysis of major abdominal surgery. Ann Surg. 2018;267(1):57-65. doi:10.1097/SLA.0000000000002267.
Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38(6):1531-41.
Zhuang CL, Ye XZ, Zhang CJ, Dong QT, Chen BC, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56(5):667-78.
Visioni A, Shah R, Gabriel E, Attwood K, Kukar M, Nurkin S. Enhanced recovery after surgery for noncolorectal surgery?: a systematic review and meta-analysis of major abdominal surgery. Ann Surg. 2018;267(1):57-65.
Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R, et al. Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the POWER study. JAMA Surg. 2019;154(8):725-36.
Varadhan KK, Neal KR, Dejong CHC, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(4):434-40.
Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189-98.
Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961-9.
Tazreean R, Asaad M, Younan HC, et al. Early ambulation and its impact on surgical outcomes: a literature review. J Clin Med Res. 2022;14(3):171-9.
Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr. 2012;31(6):783-800.
Stone AB, Grant MC, Pio Roda C, et al. Implementation costs of an enhanced recovery after surgery program in the United States: a financial model and sensitivity analysis based on experiences at a tertiary academic medical center. J Am Coll Surg. 2016;222(3):219-25.
Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: a review. JAMA Surg. 2017;152(3):292-8.
Gimeno-Moro A, Planellas-Giné P, Torras-Garcia C, et al. ERAS compliance impact on surgical outcomes in colorectal cancer: a multicenter study. Eur J Surg Oncol. 2021;47(9):2351-7.
Ni TG, Yang HT, Zhang H, Meng HP, Jiang G, Wang Y. Enhanced recovery after surgery programs in patients undergoing hepatectomy: a meta-analysis. World J Gastroenterol. 2015;21(30):9209-16.
Lee Y, Kim TH, Kim JW, et al. Clinical and economic outcomes of enhanced recovery after surgery (ERAS) protocols in gastric cancer surgery: a systematic review and meta-analysis. Int J Surg. 2020;80:102-13.
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