Effect of Modified ERAS Protocol on Clinical Outcomes in Pediatric Patients With Appendectomy

Effect of Enhanced Recovery After Surgery Protocol Based Care on Patient Outcomes in Children With Appendicitis: a Randomized Controlled Trial

Acute appendicitis is the most common abdominal emergency with more than 15 million cases reported worldwide. Although appendectomy is considered a safe surgical procedure, the incidence of complications is up to 10%. The Enhanced Recovery After Surgery (ERAS) has developed guidelines to improve postoperative patient outcomes. The protocol, which consists of more than 20 interventions in the preoperative, intraoperative and postoperative periods, shows that early discharge can be possible with multidisciplinary care given to surgical patients without risking patient safety.

Appendicitis is a common clinical condition and often requires emergency treatment. Although appendectomy is a safe surgical procedure, there is a risk of complications. Pain is common, especially in the postoperative period, and the lack of care management leads to delayed mobilization and oral intake, delayed recovery and prolonged length of hospital stay. However, pain, nausea-vomiting, thirst, fear and stress could be managed with perioperative care. In addition, it is reported that the care provided based on the ERAS protocol shortens the length of hospital stay. In this respect, the aim of this study was to investigate the effect of ERAS protocol-based care on the length of hospital stay of children who were planned to undergo appendectomy. Postoperative pain level, stress and fear level, time to first mobilization, flatulence, defecation and oral intake, nausea, thirst were the secondary outcomes of this study.

Inclusion Criteria:

• Age ≥6 years and ≤17 years, girls or boys
• Underwent appendectomy
• Written informed consent or requirements of local/national ethical committee

Exclusion Criteria:

• ASA (American Society of Anesthesiologists, ASA) score of ≥ 3
• Any comorbidity/contraindication that may prevent mobilization and oral feeding

The withdrawal criteria:

• During the surgery, the surgeon classified appendicitis as grade 0 (no appendicitis) or grade IIIB and above,
• during the postoperative period need for intensive care hospitalization patients in the control or the mERAS protocol group were staying in the same room,
• contraindications to the application of any intervention in the intervention group and/or the primary physician not approving the application of the intervention,
• the compliance rate of the interventions determined in the modified ERAS protocol being below 80%,
• the development of any other comorbidity (urinary calculi, intussusception, etc.),
• the change in the type of surgery during the operation, conversion from laparoscopic to open appendectomy.