Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT)

Background: Enhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy. Study design:Prospective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo). Results: Fifty patients were randomized into ERAS(n = 25) and conventional care(n = 25) groups. Ninety-two percent of patients were young males, 58 % had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 %). ERAS group had a reduced median LOH(days) (6 versus 8, p = 0.007), early recovery of bowel function(p = 0.010) and shorter times for nasogastric tube(p = 0.001), urinary catheter(p = 0.007) and drain(p = 0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p = 0.009)]. Conclusion: ERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy.