Comparison of routine care Vs assisted recovery based care in patients undergoing emergency abdominal surgery.

Recruiting

• Conditions: Disease of intestine, unspecified,

• Registration Number: CTRI/2021/05/033558
• Lead Sponsor: Jawaharlal Institute of Postgraduate Medical Education And Research JIPMER

Brief Summary

Bowel surgeries, particularly needing intestinal anastomosis have conventionally been managed by prolonged abstinence from oral intake, usage of opioid analgesics, insertion of nasogastric tube and urinary catheter etc.Enhanced  Recovery AfterSurgery (ERAS) pathway, is an integrated multidisciplinary pathway whichutilizes multimodal evidence-based approach to decrease perioperative surgicalstress, sustain postoperative physiological function and facilitate recovery insurgical patients.

The applicability ofERAS pathways has been tested in numerous elective procedures but there is adearth in the studies conducted in an emergency setting.The ERAS pathway hasbeen successfully implemented and has been found to be safe and effective inpatients undergoing emergency small bowel surgeries and perforated duodenalulcer surgeries in our Institute.But there are very fewreports evaluating the role of ERAS in emergency laparotomies for all cases ofabdominal surgeries.

Hence, this study isbeing carried out to investigate the feasibility and efficacy of ERAS pathwaysin patients undergoing emergency abdominal surgery.If found feasible andsafe with shorter length of hospitalization (LOH), the adapted ERAS pathway may be uniformly implemented inall emergency abdominal surgeries.

Detailed Description

Not available

Study Timeline

• Study Start: 2021-05-20
• Last Update Posted: 2022-05-13

Recruitment & Eligibility

• Status: Open to Recruitment
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

All consecutive patients, who present to the emergency surgi-cal team for emergency abdominal surgery, diagnosed based on clinical examination and adjunct investigations and planned for emergency laparotomy after volume resuscitation.

Exclusion Criteria

• 1.Age<18 years 2.Uncontrolled comorbid diseases.
• 3.Localized peritonitis 4.Duodenal ulcer perforation 5.American Society of Anesthesiologists physical status class 4E 6.Patients with coagulopathy (INR more than 1.5 and platelet count < 1 lakh) 7.Patients on vasopressor or ventilator support 8.Septic shock 9.Associated psychiatric or neurological illnesses 10.Pregnant patients 11.Polytrauma patients with associated non abdominal in-juries.
• 12.Patients undergoing multi visceral resection.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Length of hospitalization.	4 days to 2-3 weeks

Secondary Outcome Measures

Name	Time	Method
Time of nasogastric tube removal	when the drain is less than 300ml/day
time to first fluid diet and first solid diet	oral sips by 6 hrs and escalation to clear liquids by 12 hrs and liquid diet by 24 hrs in ERAS (study arm)
Time of drain removal	The abdominal drain, if any, will be withdrawn when the drainage is less than 100 ml/day irrespective of resumption of oral feeds.
duration of ileus and time to first bowel sound	6 hrs in ERAS (study) arm vs more than 6 hrs in Control arm
Time of removal of urinary catheter	when urine output is adequate for 24 hrs
Time for mobilization	day 1 to 2-3 weeks

Trial Locations

Locations (1)

Jawaharlal Institute of Postgraduate Medical Education & Research, Government of India.; 🇮🇳 Pondicherry, PONDICHERRY, India

Jawaharlal Institute of Postgraduate Medical Education & Research, Government of India.

🇮🇳Pondicherry, PONDICHERRY, India

Dr Likhita S Singh

Principal investigator

9581565705

likhitassingh@gmail.com