Post-operative Outcomes within Enhanced Recovery After Surgery: A Comparative Study of Multisystem Outcomes

Background: – Since ages, good surgical practices have included methods that subject patients to various bodily stresses such as fasting periods with extensive bowel preparations,drains and tubing, nil per oral status in pre- and post operative periods, and strict bed rest. The enhanced recovery after surgery (ERAS) protocol was designed to reduce the length of hospital stay, relieve patients’ psychological stress response, and reduce peri operative complications. Methods -: After comprehensive data collection, the study protocol was designed considering The SAGES/ERAS ® – Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery. A total of 52 oncosurgical cases were studied. Pre-, intra-, and post operative outcomes were ecorded,and using ANOVA, observations related to various organ systems involved in the surgery, such as gastrointestinal, genitourinary, hepatopancreatobiliary andgynecological, were compared. The included surgeries were gastrectomies, pancreatobiliary resections, colorectal resections, nephrectomies, radical cystectomies, Wertheim’s hysterectomies, total abdominal hysterectomies, and bilateral salpingo-oophorectomies. Results –: ANOVA revealed that the mean operative times; mean blood loss; nasogastric tube retention period; mean day of appearance of bowel sounds and that of passage of flatus; mean
ambulation day; and visual analog scores on days 1, 3, and at discharge did not differ significantly (P < 0.05) for any given surgery performed as per the protocol irrespective of the organ system involved. However, mean values of number of drains; epidural catheter removal; Foley’s catheter removal; and day of starting oral sips, liquid diet, soft diet, and full diet were significantly different for various organ systems operated as per the protocol. Conclusion -: Conventional attitudes, fundamental changes, and non intuitive protocols have found an uneasy reception in most of the surgeons. ERAS is feasible to use in vivid abdominal onco-surgeries because it renders shorter hospital stays. Quicker return to physiological normalcy without morbidity and mortality risks to patients is the foremost advantage in most of the cases.