Application of enhanced recovery pathway in abdominal wall reconstruction surgery in a tertiary care hospital in Andhra Pradesh

Abstract

Aim & Objective: Enhanced recovery pathways are well-defined perioperative evidence based interventions in a protocol manner for standardising techniques involved in drug selection, dose, reduce cost and facilitate in early discharge by monitoring mortality rates. The hypothesis of the study is the application of enhanced recovery pathway after surgery in abdominal wall reconstruction could result in potential decrease in hospital stay. Methods: The study is performed in the period of February 2017 to June2019 and a total of 100 cases and 100 controls undergoing abdominal wall reconstruction were included. Enhanced recovery pathway after surgery is used to identify the results with respect to duration of the stay. Results: It was observed from the study results that, there was no change noted in the duration of stay and regular diet. The readmission rate is decreased and in analysis of subgroups we found, factors associated with duration of the stay were < 5 days with hernia. Conclusion: To conclude, administration of enhanced recovery pathways after surgery could not show a limitation in duration of stay. It was obviously noted that quality of baseline life scores, less operative times and small hernia defects were in coordination with duration of stay. Introduction Enhanced recovery programs have shown to be safer and effective to traditional care. The implementations of enhanced recovery protocols are associated with decreased or invariable morbidity and mortality. The use of Enhanced recovery after surgery in open and laproscopic surgeries were studied and the use of this expanded to other specialities like genitourinary, orthopaedic and other organ based operation [1-3]. Another important feature of Enhanced Recovery protocols is their ability to accelerate to return of organ function or prevent their decline. In the other hand, ERAS pathways have the ability to improve patient quality of life in case of long term post-surgical periods. The factors like reduced need for day time sleep reduced fatigue, reduced number of days that patients require sick leave all been reported in patients for whom ERAS was implemented [4-6]. The ERAS protocols are also been developed for ventral hernia repair, demonstrating shorter times to regular diet and a decrease in LOS by > 2. Although these studies suggest a benefit of enhanced recovery pathways for patients undergoing ventral hernia repair, the utility of ERAS pathways in complex abdominal wall reconstruction with larger defect requiring separation of components remains largely unknown. Therefore, the study hypothesis is that implementation of an ERAS pathway for ARW would result in faster recovery and decreased LOS [7-10] .