Early Oral Feeding vs Traditional Post-operative Care In Emergency Abdominal Surgeries

College of Physicians and Surgeons Pakistan36 enrolled

Overview

ABSTRACT BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been widely studied in elective abdominal surgeries and have shown better outcomes. However the utility of these protocols in emergency abdominal surgeries has not been widely investigated. OBJECTIVE: To study the outcomes of application of ERAS protocols in patients undergoing perforated duodenal ulcers repairs in emergency abdominal surgeries. METHODS: This randomized controlled trial was conducted in Surgical Unit 1 BBH from August 2018 to December 2019 with a total sample size of 36 patients with the diagnosis of perforated duodenal ulcer. Patients were randomly divided in two groups. Group A consisted of early oral feeding group and group B consisted of traditional postoperative care group. Outcome results studied were the length of hospital stay, duodenal repair site leak, severity of pain (VAS score) and duration of post-operative ileus. Results were analysed on SPSS version 20 and chi-square and independent t-test were applied. KEY WORDS: Perforated duodenal ulcer, ERAS protocol, randomized controlled trial, duodenal repair site leak, length of hospital stay, VAS score, post-operative ileus

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

DOUBLE

Enrollment

Conditions

Perforated Duodenal Ulcer

Interventions

Early oral feeding/Enhanced recovery after surgery protocolsDIETARY_SUPPLEMENT

Early oral feeding refers to NG tube and foley's catheter removed within 12 hours and patients allowed oral sips on day 1 with gradual shift to liquid diet after 12 hrs and semisolid food started after 24 hours later.Patients were given i/v antibiotics,painkillers and i/v PPIs and shifted to oral pain killers on 2nd POD.

Eligibility

Sex: ALLMin age: 15 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * All patients older than 15 years with acute abdominal symptoms admitted in ER department, suspected as perforated duodenal ulcer and operated within 24 hours of admission by emergency department surgeon. Exclusion Criteria: * Patients presenting with the following criteria were excluded: * Refusal to join the study * Peptic ulcers with both bleeding and perforation. * Spontaneously sealed off perforations. * Malignant ulcers * Concurrent extra-abdominal surgery * Oral incapacity i.e endotracheal intubation * Reoperation within a month * ASA grade III/IV * Alternative per operative diagnosis.

Outcomes

Primary Outcomes

Length of hospital stay

Length of hospital stay is defined as duration of single episode of hospitalization. Inpatient days are calculated by subtracting day of admission from day of discharge

Time frame: upto 10 Days

DAYS OF RETURN OF BOWEL FUNCTION.

It is defined as time to passage of flatus or stools after abdominal surgery.

Time frame: Upto 24 hours

Pain score by Visual Analog Scale

Pain is defined as "an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms" according to International Association for the Study of Pain,measured by Visual Analog Scale(VAS).

Time frame: upto 36 hours

Secondary Outcomes

Bleeding peptic ulcer

Frequency of bleeding peptic ulcer

Time frame: intraoperative period

Mortality rate

Estimation of mortality rate associated with perforated duodenal ulcer

Time frame: immediate postoperative period