1. Applying enhanced recovery principles to emergency laparotomy in penetrating abdominal trauma: a case-matched study.
- Author
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Fonseca, Mariana Kumaira, Rizental, Laís Borges, da Cunha, Carlos Eduardo Bastian, Baldissera, Neiva, Wagner, Mário Bernardes, and Fraga, Gustavo Pereira
- Subjects
ABDOMINAL surgery ,QUESTIONNAIRES ,HOSPITAL emergency services ,SEVERITY of illness index ,TREATMENT effectiveness ,DESCRIPTIVE statistics ,ENHANCED recovery after surgery protocol ,ABDOMINAL injuries ,OPIOID analgesics ,LENGTH of stay in hospitals ,PENETRATING wounds - Abstract
Purpose: The implementation of enhanced recovery after surgery programs (ERPs) has significantly improved outcomes within various surgical specialties. However, the suitability of ERPs in trauma surgery remains unclear. This study aimed to (1) design and implement an ERP for trauma laparotomy patients; (2) assess its safety, feasibility, and efficacy; and (3) compare the outcomes of the proposed ERP with conventional practices. Methods: This case-matched study prospectively enrolled hemodynamically stable patients undergoing emergency laparotomy after penetrating trauma. Patients receiving the proposed ERP were compared to historical controls who had received conventional treatment from two to eight years prior to protocol implementation. Cases were matched for age, sex, injury mechanism, extra-abdominal injuries, and trauma scores. Assessment of intervention effects were modelled using regression analysis for outcome measures, including length of hospital stay (LOS), postoperative complications, and functional recovery parameters. Results: Thirty-six consecutive patients were enrolled in the proposed ERP and matched to their 36 historical counterparts, totaling 72 participants. A statistically significant decrease in LOS, representing a 39% improvement in average LOS was observed. There was no difference in the incidence of postoperative complications. Opioid consumption was considerably lower in the ERP group (p < 0.010). Time to resumption of oral liquid and solid intake, as well as to the removal of nasogastric tubes, urinary catheters, and abdominal drains was significantly earlier among ERP patients (p < 0.001). Conclusion: The implementation of a standardized ERP for the perioperative care of penetrating abdominal trauma patients yielded a significant reduction in LOS without increasing postoperative complications. These findings demonstrate that ERPs principles can be safely applied to selected trauma patients. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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