Modified enhanced recovery after surgery protocol for pediatric complicated appendicitis in a Mexican tertiary hospital: a randomized clinical trial.

BACKGROUND/

OBJECTIVES

Acute appendicitis often requires emergency surgery and leads to prolonged length of hospital stay (LOS). Enhanced recovery after surgery (ERAS) protocol promotes rapid recovery and shorter hospital stays, revolutionizing the management of pediatric surgery. The aim of the study was to evaluate the safety and efficacy of an ERAS therapeutic protocol for postoperative management in children with complicated appendicitis compared with conventional treatment.

METHODS

A single-blind, randomized controlled clinical trial was performed on patients diagnosed with complicated appendicitis between July 1 and December 31, 2022. Patients were randomly assigned to either the control group, which received conventional triple antibiotic treatment and oral feeding after restoring intestinal transit, or ERAS group, which received double antibiotic regimen, nausea prevention, and oral feeding 6 h after appendectomy. We analyzed LOS and the incidence of postoperative morbidity. The trial was registered at the Local Health Research and Ethics Committee (identifier R-2022-1302-056) and ClinicalTrials.gov ( https://www.clinicaltrials.gov/ ; identifier NCT05511194; 01/31/2023).

RESULTS

Forty patients, 70% male, average age 8 years, were included. Twenty patients received ERAS protocol management, while 20 received conventional management. The ERAS group had a shorter average LOS (3.15 days vs. 5.20 days, p = 0.001). Postoperative minor morbidities were similar between the groups.

CONCLUSION

The modified ERAS protocol reduced LOS and did not increase postoperative morbidity.