Clinical Science
Enhanced postoperative recovery pathways in emergency surgery: a randomised controlled clinical trial

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Abstract

Background

Enhanced recovery pathways are now widely used in elective surgical procedures. The feasibility of enhanced postoperative recovery pathways in emergency surgery for perforated peptic ulcer disease was investigated in this randomized controlled clinical trial.

Methods

Patients with perforated peptic ulcer disease who underwent laparoscopic repair were randomized into 2 groups. Group 1 patients were managed with standard postoperative care and group 2 patients with enhanced postoperative recovery pathways. The primary endpoints were the length of hospital stay and morbidity and mortality.

Results

Forty-seven patients were included in the study. There were 26 patients in group 1 and 21 in group 2. There were no significant differences in the morbidity and mortality rates, whereas the length of hospital stay was significantly shorter in group 2.

Conclusions

The application of enhanced postoperative recovery pathways in selected patients with perforated peptic ulcer disease who undergo laparoscopic Graham patch repair seems feasible.

Section snippets

Study design, eligibility, randomization, and exclusion criteria

This study was a prospective, single-center, randomized controlled, nonblinded clinical study. The aim of the study was to evaluate the safety and efficacy of enhanced postoperative recovery pathways in patients who underwent laparoscopic Graham patch repair (LGPR) for PPUD. Patients who were diagnosed with PPUD between May 2012 and January 2013 were recruited for the study. The Institutional Review Board of the Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey, approved this

Results

The details of the enrollment process are shown on a CONSORT 2010 flow diagram in Fig. 1.12 Twenty-six patients in the control group and 21 in the ERAS group were considered for statistical analysis.

The female-to-male ratio in the control and ERAS groups was 6 of 20 and 5 of 16, respectively. The mean age of patients in the control and ERAS groups was 37.8 ± 14.3 years (range 18 to 71 years) and 35.4 ± 13.2 years (range 18 to 66 years), respectively (P = .56). PPUD was located in the anterior

Comments

Age older than 60 years, shock on admission, and concomitant systemic diseases are well-established risk factors that influence outcomes of patients who undergo emergency surgery for PPUD.13, 14 The favorable outcomes in the present study were most likely caused by the fact that almost all patients with these risk factors were excluded. Likewise, the overall mortality rate (2%) and the mortality rate of each group (4% and 0%) were less than that previously reported in the literature (6% to 30%).

Acknowledgments

The authors thank Bilgi Baca, Elcin Coskun, and Halit Gonenc for providing essential data and statistical analysis.

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    The authors declare no conflict of interest.

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