Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma

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dc.contributor.advisorNavsaria, Pradeep Hen_ZA
dc.contributor.authorMoydien, Mahammed Riyaaden_ZA
dc.date.accessioned2016-02-01T10:15:19Z
dc.date.available2016-02-01T10:15:19Z
dc.date.issued2015en_ZA
dc.descriptionIncludes bibliographical referencesen_ZA
dc.description.abstractIntroduction: ERAS programmes employed in elective colorectal, vascular, urologic and orthopaedic surgery has provided strong evidence for decreased lengths of hospital stay without increase in postoperative complications. Aim: The aim of this study was to explore the role and benefits, if any, of ERAS / ERP (early recovery programmes) implemented in patients undergoing emergency laparotomy for trauma at a level 1 trauma centre. Methods: Institutional UCT-HREC approved study. A prospective cohort of 38 consecutive patients with isolated penetrating abdominal trauma undergoing emergency laparotomy were included in the study. The ERP included: early feeding, early urinary catheter removal, early mobilisation/physiotherapy, early intravenous line removal and early optimal oral analgesia. This group was compared to a historical control group of 40 consecutive patients undergoing emergency laparotomy for penetrating abdominal trauma, prior to introduction of ERP. Demographics, mechanism of injury and injury severity scores (ISS and PATI) were determined for both groups. The primary end-points were the length of hospital stay and incidence of complications (Clavien-Dindo classification) in the 2 groups. The difference in means was tested using the t-test assuming unequal variances. Statistical significance was defined as p < 0.05. Results: The two groups were comparable with regards to age, gender, mechanism of injury and ISS and PATI scores. The mean time to solid diet, urinary catheter removal and NGT removal was (non ERAS) 3.6 and (ERAS) 2.8 days [p < 0.035], (non ERAS) 3.3 and (ERAS) 1.9 days [p < 0.00003], (non ERAS) 2.1 and (ERAS) 1.2 days [p < 0.0042], respectively. There was no difference in time from admission to time of laparotomy [(non ERAS) 313 vs. (ERAS) 358] min (p < 0.07). There were 11 and 12 complications in the control and study group, respectively. When graded as per the Clavien-Dindo classification there was no significant difference in the 2 groups (p < 0.59). Hospital stay was significantly shorter in the ERAS group: 5.5 (SD 1.8) days vs. 8.4 (SD 4.2) days [p < 0.00021]. Conclusion: This small pilot study shows that ERPs can be successfully implemented with significant shorter hospital stays without any increase in postoperative complications in trauma patients undergoing laparotomy for penetrating abdominal trauma. Furthermore, the study shows that ERP can also be applied to patients undergoing emergency surgery.en_ZA
dc.identifier.apacitationMoydien, M. R. (2015). <i>Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Surgery. Retrieved from http://hdl.handle.net/11427/16657en_ZA
dc.identifier.chicagocitationMoydien, Mahammed Riyaad. <i>"Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Surgery, 2015. http://hdl.handle.net/11427/16657en_ZA
dc.identifier.citationMoydien, M. 2015. Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Moydien, Mahammed Riyaad AB - Introduction: ERAS programmes employed in elective colorectal, vascular, urologic and orthopaedic surgery has provided strong evidence for decreased lengths of hospital stay without increase in postoperative complications. Aim: The aim of this study was to explore the role and benefits, if any, of ERAS / ERP (early recovery programmes) implemented in patients undergoing emergency laparotomy for trauma at a level 1 trauma centre. Methods: Institutional UCT-HREC approved study. A prospective cohort of 38 consecutive patients with isolated penetrating abdominal trauma undergoing emergency laparotomy were included in the study. The ERP included: early feeding, early urinary catheter removal, early mobilisation/physiotherapy, early intravenous line removal and early optimal oral analgesia. This group was compared to a historical control group of 40 consecutive patients undergoing emergency laparotomy for penetrating abdominal trauma, prior to introduction of ERP. Demographics, mechanism of injury and injury severity scores (ISS and PATI) were determined for both groups. The primary end-points were the length of hospital stay and incidence of complications (Clavien-Dindo classification) in the 2 groups. The difference in means was tested using the t-test assuming unequal variances. Statistical significance was defined as p < 0.05. Results: The two groups were comparable with regards to age, gender, mechanism of injury and ISS and PATI scores. The mean time to solid diet, urinary catheter removal and NGT removal was (non ERAS) 3.6 and (ERAS) 2.8 days [p < 0.035], (non ERAS) 3.3 and (ERAS) 1.9 days [p < 0.00003], (non ERAS) 2.1 and (ERAS) 1.2 days [p < 0.0042], respectively. There was no difference in time from admission to time of laparotomy [(non ERAS) 313 vs. (ERAS) 358] min (p < 0.07). There were 11 and 12 complications in the control and study group, respectively. When graded as per the Clavien-Dindo classification there was no significant difference in the 2 groups (p < 0.59). Hospital stay was significantly shorter in the ERAS group: 5.5 (SD 1.8) days vs. 8.4 (SD 4.2) days [p < 0.00021]. Conclusion: This small pilot study shows that ERPs can be successfully implemented with significant shorter hospital stays without any increase in postoperative complications in trauma patients undergoing laparotomy for penetrating abdominal trauma. Furthermore, the study shows that ERP can also be applied to patients undergoing emergency surgery. DA - 2015 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma TI - Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma UR - http://hdl.handle.net/11427/16657 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16657
dc.identifier.vancouvercitationMoydien MR. Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Surgery, 2015 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/16657en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Surgeryen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherSurgeryen_ZA
dc.titleEnhanced recovery after surgery (ERAS) in penetrating abdominal traumaen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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