Laparotomy
Conditions
Brief summary
The main goal of ERAS is to enhance the recovery of patients, and this has secondary effects, such reduced length of hospital stay, minimal postoperative complications and lessen readmission rates. ERAS protocols have been shown to be feasible and safe across the world. Although it has been shown to be effective in the developed settings and can potentially reduce the length of hospital stay, and the cost of healthcare in the perioperative period. The multimodal program of ERAS has been less implemented in the low and middle income African countries. Studies done outside Uganda (Egypt and South Africa) have demonstrated that ERAS program can be feasible and yields favorable outcomes in patients.
Detailed description
The efficacy of ERAS has been demonstrated in resource rich settings but limited evidence is available from resource poor settings. The aim of this study was to determine the feasibility and test efficacy of ERAS in reducing length of post-operative hospital stay and the incidence of postoperative complications compared to the standard of care as the control group. 33 participants above 18 years of age, undergoing laparotomy, were randomly assigned to an intervention (ERAS) arm or to a control (standard surgical care) arm at Mbarara Regional Referral Hospital in Uganda. The ERAS and the control arm had 16 and 17 patients respectively, followed-up 14 days after surgery. Patients in the ERAS arm had 2.4 days (SD 0.7) of post-operative hospital stay shorter than those in the control arm, p=0.0025 (4.1±0.2 vs 6.5±0.6 respectively). 18.8% of patients in the control arm developed post-operative complications compared to 5.9% in the ERAS arm (Statistical insignificance, p=0.34). ERAS patients passed flatus eight hours earlier than patients in the control arm, and mobilisation out of bed happened 12 hours earlier in the ERAS group p value=0.4. ERAS is feasible at Mbarara Regional Referral Hospital, and it leads to reduced hospital stay duration but not post-operative complications in laparotomy cases.
Interventions
DIETARY_SUPPLEMENTCarbohydrate drink load
Administration of 5% Dextrose orally as a carbohydrate drink load two hours before surgery and as an oral sips eight hours after the surgery.
COMBINATION_PRODUCTEnhanced Recovery After Surgery (ERAS)
The ERAS intervention consisted of exposing patients to ERAS protocol of care as described by the ERAS Society® for the entire perioperative period. However, some of these ERAS protocols were modified to our local resources and requirements.
Sponsors
Mbarara University of Science and Technology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Participants were randomly allocated into two arms: intervention arm (ERAS) and control arm
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* We enrolled adult patients, 18 years of age and above, scheduled for non-emergency laparotomy.
Exclusion criteria
* Patients with age less than 18 years * Pregnant patients * Emergency Laparotomy * American Society of Anesthesiologists (ASA) physical status score greater than 3 * Surgeries other than elective gastrointestinal laparotomy * Diabetes patients
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Length of hospital stay | From the day of surgical operation up to time 14 days | It is the duration of a single episode of hospitalization measured as time . |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Perioperative morbidity and mortality | From the start of surgical intervention to 14 days after discharge from the hospital | Adverse events or death occurring during or 14 days after the surgical operation |
| Readmission rate | Within 14 days from the day of discharge from the hospital | Admission of a patient in the hospital within 14 days after discharge |
Countries
Uganda
Outcome results
None listed