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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| mERAS Group | Experimental |
|
|
| Standart Care Group | No Intervention | Patients in this group will receive standard care according to the practices of the clinic where the study will be conducted. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Education and counselling | Other | Education and counselling of patients and their parents |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative length of hospital stay | The postoperative length of hospital stay will be calculated in hours. Higher scores indicate delayed discharge. This means a worse outcome. | From the end of surgery until hospital discharge, up to 10 days |
| Measure | Description | Time Frame |
|---|---|---|
| Complications | Postoperative minor and major complications will be recorded. | up to 30 days after discharge |
| Readmission | Readmission to the hospital will be recorded in hours. |
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Inclusion Criteria:
Exclusion Criteria:
The withdrawal criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Buket MERAL, Msc | Karadeniz Technical University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Karadeniz Technical University | Trabzon | Trabzon | 61080 | Turkey (Türkiye) |
The individual participant data, with identifying information concealed, forming the basis of the results reported in this article, will be made available upon reasonable request to the corresponding author 6-12 months after publication of the article. Researchers should contact the corresponding author to request access to the data.
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| Avoiding the use of nasogastric catheters, drains and urinary catheters |
| Other |
Avoiding the use of nasogastric catheters, drains and urinary catheters or/and removing them as early as possible |
|
| Stimulation of intestinal motility in the postoperative period | Other | Stimulation of intestinal motility in the postoperative period |
|
| Initiation of oral intake in the early postoperative period | Other | Initiation of oral intake in the early postoperative period |
|
| Early removal of the patient by reducing postoperative IV fluid infusion | Other | Early removal of the patient by reducing postoperative IV fluid infusion |
|
| Initiation of early mobilization of the patient in the postoperative period | Other | Initiation of early mobilization of the patient in the postoperative period |
|
| Reducing opioid use and ensuring pain management | Other | Reducing opioid use and ensuring pain management |
|
| Implement nausea and vomiting prophylaxis | Other | Implement nausea and vomiting prophylaxis |
|
| Management of thirsty | Other | Management of thirsty |
|
| Management of fear and stress | Other | Use of recommended non-pharmacological interventions in the management of fear and stress |
|
| up to 30 days after discharge |
| Postoperative pain | Postoperative pain will be evaluated with Numeric Pain Scale. Higher scores mean more severe pain, worse outcome | Assessed 5 times on the day of surgery (Postoperative Day 0) after patient awakening, approximately every 4-6 hours |
| Postoperative fear | Postoperative fear will be evaluated with Children's Fear Scale. Higher scores mean more severe fear, worse outcome. | Assessed 2 times on the day of surgery (Postoperative Day 0) after patient awakening, approximately every 12 hours |
| Postoperative anxiety | Postoperative anxiety will be evaluated with Children's State Anxiety. Higher scores mean more severe anxiety, worse outcome. | Assessed 2 times on the day of surgery (Postoperative Day 0) after patient awakening, approximately every 12 hours |
| Postoperative nausea-vomiting | Postoperative nausea-vomiting will be evaluated with Baxter Retching Faces Scale. Higher scores mean more severe nause, worse outcome | Assessed 5 times on the day of surgery (Postoperative Day 0) after patient awakening, approximately every 4-6 hours |
| Postoperative thirst | Postoperative thirst will be evaluated with Numeric Thirst Scale. Higher scores mean more severe pain, worse outcome. | up to the first oral intake, an average 2 days |
| Time of first mobilization | The first time of postoperative mobilization will be recorded in hours. Higher scores indicate delayed mobilization. This means a worse outcome. | up to the first mobilization, an average 12 hours |
| Time of first defecation | The first time of postoperative defecation will be recorded in hours. Higher scores indicate delayed defecation. This means a worse outcome. | up to the first defecation, an average 3 days |
| ID | Term |
|---|---|
| D001064 | Appendicitis |
| D010146 | Pain |
| D001008 | Anxiety Disorders |
| D014839 | Vomiting |
| ID | Term |
|---|---|
| D059413 | Intraabdominal Infections |
| D007239 | Infections |
| D005759 | Gastroenteritis |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
| D002429 | Cecal Diseases |
| D007410 | Intestinal Diseases |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001523 | Mental Disorders |
| D012817 | Signs and Symptoms, Digestive |
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| ID | Term |
|---|---|
| D004522 | Educational Status |
| D003376 | Counseling |
| D004322 | Drainage |
| D062885 | Urinary Catheters |
| ID | Term |
|---|---|
| D012959 | Socioeconomic Factors |
| D011154 | Population Characteristics |
| D008605 | Mental Health Services |
| D004191 | Behavioral Disciplines and Activities |
| D003153 | Community Health Services |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
| D013812 | Therapeutics |
| D013514 | Surgical Procedures, Operative |
| D057785 | Catheters |
| D004864 | Equipment and Supplies |
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