Appendicitis, ERAS, Surgery
Conditions
Keywords
Appendectomy, Nurse, Child, Pain, Length of Stay, Anxiety, Fear, Vomiting
Brief summary
Acute appendicitis is the most common abdominal emergency with more than 15 million cases reported worldwide. Although appendectomy is considered a safe surgical procedure, the incidence of complications is up to 10%. The Enhanced Recovery After Surgery (ERAS) has developed guidelines to improve postoperative patient outcomes. The protocol, which consists of more than 20 interventions in the preoperative, intraoperative and postoperative periods, shows that early discharge can be possible with multidisciplinary care given to surgical patients without risking patient safety.
Detailed description
Appendicitis is a common clinical condition and often requires emergency treatment. Although appendectomy is a safe surgical procedure, there is a risk of complications. Pain is common, especially in the postoperative period, and the lack of care management leads to delayed mobilization and oral intake, delayed recovery and prolonged length of hospital stay. However, pain, nausea-vomiting, thirst, fear and stress could be managed with perioperative care. In addition, it is reported that the care provided based on the ERAS protocol shortens the length of hospital stay. In this respect, the aim of this study was to investigate the effect of ERAS protocol-based care on the length of hospital stay of children who were planned to undergo appendectomy. Postoperative pain level, stress and fear level, time to first mobilization, flatulence, defecation and oral intake, nausea, thirst were the secondary outcomes of this study.
Interventions
OTHEREducation and counselling
Education and counselling of patients and their parents
OTHERAvoiding the use of nasogastric catheters, drains and urinary catheters
Avoiding the use of nasogastric catheters, drains and urinary catheters or/and removing them as early as possible
OTHERStimulation of intestinal motility in the postoperative period
Stimulation of intestinal motility in the postoperative period
OTHERInitiation of oral intake in the early postoperative period
Initiation of oral intake in the early postoperative period
OTHEREarly removal of the patient by reducing postoperative IV fluid infusion
Early removal of the patient by reducing postoperative IV fluid infusion
OTHERInitiation of early mobilization of the patient in the postoperative period
Initiation of early mobilization of the patient in the postoperative period
OTHERReducing opioid use and ensuring pain management
Reducing opioid use and ensuring pain management
OTHERImplement nausea and vomiting prophylaxis
Implement nausea and vomiting prophylaxis
OTHERManagement of thirsty
Management of thirsty
OTHERManagement of fear and stress
Use of recommended non-pharmacological interventions in the management of fear and stress
Sponsors
Karadeniz Technical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
6 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥6 years and ≤17 years, girls or boys * Underwent appendectomy * Written informed consent or requirements of local/national ethical committee
Exclusion criteria
* ASA (American Society of Anesthesiologists, ASA) score of ≥ 3 * Any comorbidity/contraindication that may prevent mobilization and oral feeding The withdrawal criteria: * During the surgery, the surgeon classified appendicitis as grade 0 (no appendicitis) or grade IIIB and above, * during the postoperative period need for intensive care hospitalization patients in the control or the mERAS protocol group were staying in the same room, * contraindications to the application of any intervention in the intervention group and/or the primary physician not approving the application of the intervention, * the compliance rate of the interventions determined in the modified ERAS protocol being below 80%, * the development of any other comorbidity (urinary calculi, intussusception, etc.), * the change in the type of surgery during the operation, conversion from laparoscopic to open appendectomy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative length of hospital stay | From the end of surgery until hospital discharge, up to 10 days | The postoperative length of hospital stay will be calculated in hours. Higher scores indicate delayed discharge. This means a worse outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Readmission | up to 30 days after discharge | Readmission to the hospital will be recorded in hours. |
| Postoperative pain | Assessed 5 times on the day of surgery (Postoperative Day 0) after patient awakening, approximately every 4-6 hours | Postoperative pain will be evaluated with Numeric Pain Scale. Higher scores mean more severe pain, worse outcome |
| Postoperative fear | Assessed 2 times on the day of surgery (Postoperative Day 0) after patient awakening, approximately every 12 hours | Postoperative fear will be evaluated with Children's Fear Scale. Higher scores mean more severe fear, worse outcome. |
| Postoperative anxiety | Assessed 2 times on the day of surgery (Postoperative Day 0) after patient awakening, approximately every 12 hours | Postoperative anxiety will be evaluated with Children's State Anxiety. Higher scores mean more severe anxiety, worse outcome. |
| Complications | up to 30 days after discharge | Postoperative minor and major complications will be recorded. |
| Postoperative thirst | up to the first oral intake, an average 2 days | Postoperative thirst will be evaluated with Numeric Thirst Scale. Higher scores mean more severe pain, worse outcome. |
| Time of first mobilization | up to the first mobilization, an average 12 hours | The first time of postoperative mobilization will be recorded in hours. Higher scores indicate delayed mobilization. This means a worse outcome. |
| Time of first defecation | up to the first defecation, an average 3 days | The first time of postoperative defecation will be recorded in hours. Higher scores indicate delayed defecation. This means a worse outcome. |
| Postoperative nausea-vomiting | Assessed 5 times on the day of surgery (Postoperative Day 0) after patient awakening, approximately every 4-6 hours | Postoperative nausea-vomiting will be evaluated with Baxter Retching Faces Scale. Higher scores mean more severe nause, worse outcome |
Countries
Turkey (Türkiye)
Outcome results
None listed