Enhanced Recovery After Surgery Programs Safely Accelerate Recovery in Emergency Abdominal Surgery: A Randomized Controlled Trial With Multivariable Risk Profiling.

BACKGROUND

Emergency abdominal surgery involves complex, diverse conditions with high patient variability, posing recovery challenges. While Enhanced Recovery After Surgery (ERAS) programs benefit elective surgery and show promise in emergencies, current research is disease-specific, limiting broad assessment. This study evaluates ERAS safety/effectiveness across multiple emergency abdominal conditions and identifies recovery risk factors.

METHODS

This single-blind trial randomized 305 emergency abdominal surgery patients to ERAS (n = 151) or conventional care (n = 154). ERAS patients underwent perioperative enhanced recovery programs, while controls received conventional management. The primary outcome was time to postoperative recovery criteria. Secondary outcomes included first postoperative flatus/semi-liquid diet tolerance time, complication rates, maximum pain scores (days 1-5), 30-day readmissions, and satisfaction. Data were analyzed via t-tests, Mann-Whitney U, Fisher's exact tests, and multivariate regression (p < 0.05 significance).

RESULTS

ERAS reduced median recovery time (141 h [IQR: 114-179] vs. 163 h [IQR: 131-204], p < 0.001), accelerated gastrointestinal recovery (first flatus: 1.10 vs. 1.30 days; semi-liquid tolerance: 3.60 vs. 4.10 days, both p < 0.05), and improved satisfaction (95 vs. 91, p < 0.001). No differences in complications (11.9% vs. 15.6%, p = 0.353) or 30-day readmissions (2.0% vs. 2.6%, p > 0.999). Shock index and APACHE II were common risk factors; ERAS-specific risks included SOFA (OR = 1.31, 1.03-1.71, p = 0.034), preoperative hemoglobin (OR = 0.95, 0.89-1.00, p = 0.046), preparation time (OR = 0.33, 0.14-0.68, p = 0.005), and blood transfusion (OR = 0.01, 0.00-0.23, p = 0.003).

CONCLUSION

ERAS enhances postoperative recovery and satisfaction in emergency abdominal surgery without increasing complications/readmissions. Identified risk factors support personalized protocols, advancing ERAS implementation.