Comparative study between Enhanced Recovery After Surgery versus conventional peri-operative care in elective gastrointestinal surgery and compliance to ERAS protocols at an Indian tertiary care public hospital

Abstract

Abstract Introduction: The benefits of fast track surgery protocols have been well established for abdominal surgeries. They are now being used for other surgeries also including urology and even neurosurgery. However very few Indian public hospitals implement these protocols. There is difficulty in complying to the stated protocols. Materials and Methods:A prospective randomized control study carried out from September, 2021 to October, 2022 at the Department of General Surgery, Sir Sayajirao General Hospital, Vadodara amongst all patients undergoing elective abdominal surgeries. Patients were divided into two groups (ERAS and Control) by closed envelope technique, each having 30 patients. ERAS group patients received peri-operative care defined by ERAS criteria while the control group patients received conventional care. Results: Stoma closure was the most commonly performed surgery among both groups. The mean time of starting liquids was 1.2 ± 0.4 days in the ERAS group compared to 4.4 ± 0.8 days in the control group. Soft diet was also started early in the ERAS group (2.2 ± 0.4 days vs 5.7 ± 1.2 days.) The mean time of first defecation was 2.4 ± 0.6 days in the ERAS group and 4.7 ± 0.9 days in the control group. Foley’s catheter inserted intra-operatively was removed after a mean 1.3 ± 0.7 days in the ERAS group compared to 1.7 ± 0.9 days in the control group. The patients in ERAS group needed an average of 3.3 days of post op IV opioid analgesia as compared to 4.5 days of control group. The mean length of hospital stay was 13.2 ± 6.2 days for the ERAS group compared to 19.3 ± 8.8 days in the control group. Total number of patients who developed complications were 7 in ERAS group and 18 in control group. The compliance to pre-, peri-, and post-operative components was 80%, 65% and 88.3% respectively. Conclusion: Due to the significantly decreased length of stay and lesser complications, ERAS protocols, or at least some elements of the ERAS protocols can be implemented even in the public hospital setup. Higher bed turnover ratio can help in maximizing the benefits of the existing resources to help more number of patients.