Background

Laparoscopic appendectomy (LA) is a widely used surgical procedure. Patients often suffer from considerable postoperative pain and indigestion, which prolongs their in-hospital stay. Almost 10% of patients develop postoperative complications. The enhanced recovery after surgery (ERAS) program has proven its efficacy in elective surgery and could hypothetically improve LA outcomes. Currently, there is no ERAS program for LA.

Methods

A modified ERAS (mERAS) protocol was studied in a prospective, randomized nonblinded clinical trial. The mERAS group consisted of 50 patients; the control group, of 54 patients. The mERAS protocol included a patient information brochure; minimizing drain use; local anesthesia; low-pressure pneumoperitoneum; early mobilization and oral diet. The primary outcome was postoperative length of stay (pLOS).

Results

Modified protocol reduced median pLOS to 1.25 days vs 2 days in the controls (p < 0.0001). Twenty-one (42%) mERAS patients and 4 (7.4%) controls were discharged within 24 h (p < 0.001) after surgery; 0 readmissions were reported. Postoperative pain intensity assessed on the visual analogue scale was significantly lower in the mERAS group [mERAS vs control 0 h, 2 h, 6 h, 12 h and 24 h after surgery: 2.33 ± 2.12 vs 4.19 ± 2.08 (p < 0.0001), 2.27 ± 1.91 vs 4.02 ± 1.89 (p < 0.0001), 2.28 ± 1.98 vs 3.70 ± 1.57 (p = 0.0001), 1.98 ± 1.72 vs 3.43 ± 1.54 (p < 0.0001) and 1.80 ± 1.74 vs 3.00 ± 1.27 (p = 0.032), respectively)]. The severity of shoulder and neck pain was lower but its incidence was similar. Peristalsis recovery was achieved earlier in the study group (median (min–max))—mERAS 7 (2–34) h vs control 11 (3–43) h; p = 0.009) but did not affect the time of the first flatus 23 (2–72) h vs 29 (6–70) h, respectively; p = 0.499).

Conclusions

The modified ERAS program for LA has advantages over the traditional approach.

Registration

This trial was registered at ClinicalTrials.gov as NCT03754777 (27/11/2018).

中文翻译：

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腹腔镜阑尾切除术中实施的加速康复外科项目组成部分的评估：前瞻性随机临床研究。

背景

腹腔镜阑尾切除术（LA）是一种广泛使用的外科手术。患者常常遭受严重的术后疼痛和消化不良，这延长了他们的住院时间。近10%的患者出现术后并发症。加速康复外科 (ERAS) 计划已证明其在择期手术中的功效，并且理论上可以改善 LA 的结果。目前，洛杉矶没有 ERAS 计划。

方法

在一项前瞻性随机非盲临床试验中研究了改良的 ERAS (mERAS) 方案。mERAS 组由 50 名患者组成；对照组 54 名患者。mERAS 协议包括患者信息手册；尽量减少排水管的使用；局部麻醉；低压气腹；早期活动和口服饮食。主要结局是术后住院时间（pLOS）。

结果

修改后的方案将中位 pLOS 降低至 1.25 天，而对照组为 2 天（p  < 0.0001）。 21 名 (42%) mERAS 患者和 4 名 (7.4%) 对照者在术后24 小时内出院 ( p < 0.001)；据报道，再入院人数为 0 人。mERAS 组的术后疼痛强度通过视觉模拟量表评估显着较低[mERAS 与对照组相比，术后 0 小时、2 小时、6 小时、12 小时和 24 小时：2.33 ± 2.12 与 4.19 ± 2.08 (p <  0.0001)， 2.27 ± 1.91 对比 4.02 ± 1.89 ( p  < 0.0001)、2.28 ± 1.98 对比 3.70 ± 1.57 ( p  = 0.0001)、1.98 ± 1.72 对比 3.43 ± 1.54 ( p  < 0.0001) 和 1.80 ± 1.74 对比 3.00 ± 1.27 ( p  = 0.032 ）， 分别）]。肩颈疼痛的严重程度较低，但发生率相似。研究组较早地实现了蠕动恢复（中位（最小–最大））——mERAS 7 (2–34) 小时，而对照组则为 11 (3–43) 小时；p = 0.009），但不影响第一次排气的时间，分别为 23（2-72）小时和 29（6-70）小时；p  = 0.499）。

结论

洛杉矶修改后的 ERAS 计划比传统方法具有优势。

登记

该试验在 ClinicalTrials.gov 上注册为 NCT03754777（2018 年 11 月 27 日）。