Effect of Modified ERAS Protocol on Clinical Outcomes in Pediatric Patients With Appendectomy
Study Details
Study Description
Brief Summary
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: mERAS Group Education and counselling of patients and their parents 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 Initiation of oral intake in the early postoperative period Early removal of the patient by reducing postoperative IV fluid infusion Initiation of early mobilization of the patient in the postoperative period Reducing opioid use and ensuring pain management Implement nausea and vomiting prophylaxis Management of thirsty Management of fear and stress |
Other: Education and counselling
Education and counselling of patients and their parents
Other: Avoiding the use of nasogastric catheters, drains and urinary catheters
Avoiding the use of nasogastric catheters, drains and urinary catheters or/and removing them as early as possible
Other: Stimulation of intestinal motility in the postoperative period
Stimulation of intestinal motility in the postoperative period
Other: Initiation of oral intake in the early postoperative period
Initiation of oral intake in the early postoperative period
Other: Early removal of the patient by reducing postoperative IV fluid infusion
Early removal of the patient by reducing postoperative IV fluid infusion
Other: Initiation of early mobilization of the patient in the postoperative period
Initiation of early mobilization of the patient in the postoperative period
Other: Reducing opioid use and ensuring pain management
Reducing opioid use and ensuring pain management
Other: Implement nausea and vomiting prophylaxis
Implement nausea and vomiting prophylaxis
Other: Management of thirsty
Management of thirsty
Other: Management of fear and stress
Use of recommended non-pharmacological interventions in the management of fear and stress
|
| No Intervention: Standart Care Group Patients in this group will receive standard care according to the practices of the clinic where the study will be conducted. |
Outcome Measures
Primary Outcome Measures
- Hospital length of stay [up to 2 weeks]
The length of hospital stay will be calculated in hours. Higher scores indicate delayed discharge. This means a worse outcome.
Secondary Outcome Measures
- Complications [up to 30 days after discharge]
Postoperative minor and major complications will be recorded.
- Readmission [up to 30 days after discharge]
Readmission to the hospital will be recorded in hours.
- Postoperative pain [up to 2 weeks]
Postoperative pain will be evaluated with Numeric Pain Scale. Higher scores mean more severe pain, worse outcome
- Postoperative fear [up to 2 weeks]
Postoperative fear will be evaluated with Children's Fear Scale. Higher scores mean more severe pain, worse outcome.
- Postoperative anxiety [up to 2 weeks]
Postoperative anxiety will be evaluated with Children's State Anxiety. Higher scores mean more severe pain, worse outcome.
- Postoperative nausea-vomiting [up to 2 weeks]
Postoperative nausea-vomiting will be evaluated with Baxter Retching Faces Scale. Higher scores mean more severe pain, worse outcome
- Postoperative thirst [up to the first oral intake, an average 2 days]
Postoperative thirst will be evaluated with Numeric Thirst Scale. Higher scores mean more severe pain, worse outcome.
- Time of first mobilization [up to the first mobilization, an average 12 hours]
The first time of postoperative mobilization will be recorded in hours. Higher scores indicate delayed mobilization. This means a worse outcome.
- Time of first defecation [up to the first defecation, an average 3 days]
The first time of postoperative defecation will be recorded in hours. Higher scores indicate delayed defecation. This means a worse outcome.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Age ≥6 years and ≤18 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
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Karadeniz Technical University | Trabzon | Turkey | 61080 |
Sponsors and Collaborators
- Karadeniz Technical University
Investigators
- Principal Investigator: Buket MERAL, Msc, Karadeniz Technical University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- KaradenizTU