P-0154 Enhanced Recovery After Surgery (Eras) Program Versus Conventional Perioperative Care in Patients Undergoing Major Gastrointestinal Surgical Procedures

Abstract

ABSTRACT Introduction Enhanced Recovery After Surgery (ERAS) programs have been introduced with aims of attenuating the stress response to surgery and enabling rapid recovery, without an increase in complications or readmissions. There is strong evidence of the usefulness of ERAS programs in patients undergoing colorectal surgery, but there is limited evidence about their safety in upper gastrointestinal surgery patients because surgeons are hesitant to allow early feeding in this patient population due to the concern of the effect of eating on gastric distention and potential anastomotic leaks. The aim of this study was to evaluate whether the implication of ERAS care, when compared to traditional care, is associated with impoved morbidity and outcome in patients undergoing elective major upper and lower gastrointestinal surgery. Methods The patients operated by two individual surgeons of the department following the ERAS regime were prospectively studied and compared with those operated by the rest four surgeons following the conventional perioperative care, during a six-month period. The ERAS regime consisted of preoperative patient education, removal of nasogastric tubes immediately after surgery, total fluid intake not exceeding 2.5L/24h, management of postoperative pain with systemic administration of paracetamol and non-steroid anti-inflammatory drugs, early feeding and ambulation. The outcome measures were incidence of major postoperative complications, length of postoperative hospital stay, number of relaparotomies and readmissions, and mortality within 30 days. Data analysis was done by the use of Fisher's exact test and Student's t-test. Values of p Results Sixteen patients, treated according to the ERAS program, were compared with 38 controls who had conventional perioperative care during the same time period. The two groups were similar with respect to age (p=0.9), gender (p=0.1), ASA grade (p=0.6), type of disease (p=0.1) and type of surgery (p=0.1). There was a trend toward significantly lower incidence of major postoperative complications in the ERAS group compared to the control group (12.5% vs 42.1% respectively; p=0.052). Overall, length of stay was significantly shorter in the ERAS group (5+/_1.6 days vs 12.2+/_ 5.9 days; p Conclusion ERAS program significantly reduces the length of hospital stay and has a trend toward significantly lower incidence of major postoperative complications in patients undergoing major elective upper and lower gastrointestinal surgery. Further research is required to define its essential elements and to establish the indications and patient populations that will most greatly benefit of its implementation.