Effect of an enhanced recovery after surgery protocol for children with acute appendicitis: A randomized controlled trial.

BACKGROUND

Enhanced Recovery After Surgery protocols are multidisciplinary, multimodal perioperative care pathways to enhance recovery after surgery. Evidence regarding the implementation of these protocols in pediatric surgery is still limited.

OBJECTIVE

This study aimed to evaluate the effectiveness of nursing care based on the modified Enhanced Recovery After Surgery (mERAS) protocol on patient outcomes in children undergoing appendectomy.

METHOD: This single-center randomized controlled trial included 82 children aged 6-17 years who underwent appendectomy and their parents between October 2023 and May 2024. Patients were randomly assigned to groups (1:1). The control group received standard care, and the intervention group received mERAS protocol-based care, including perioperative education, stimulation of bowel motility, early postoperative mobilization, and non-pharmacological perioperative management. The primary outcome is the postoperative length of stay. The secondary outcomes include patient-reported anxiety, fear, pain and nausea-vomiting levels, time to first mobilization and flatus. The outcomes were analyzed using an independent groups t-test, a Mann-Whitney U test, and changes over repeated measurements were analyzed using Generalized Estimating Equations, including group, time, and group-time interaction.

RESULTS

Compliance with most mERAS interventions exceeded 85%; however, participation in activities including using a remote-controlled car, watching educational animations remained below 60%. Postoperative hospital stay was statistically significantly shorter in the intervention group (MD = -9.84 h; 95% CI: -15.53 to -4.15; p = 0,001). The times of first postoperative mobilization (MD = - 4.63 h; 95% CI: - 5.80 to -3.46; p < 0.001), and first flatus (MD = -8.31 h; 95% CI = -11.46 to -5.16; p = 0,001), were shorter in the intervention group. In the multivariate regression analysis, care based on the mERAS protocol was independently associated with a decreased risk of prolonged hospital stay (β = -8.174; 95% CI: -13.958 to -2.750; p = 0.004).

CONCLUSION

The nurse-led mERAS protocol is effective perioperative care model. This protocol has enhanced recovery in children undergoing appendectomy and improved important patient outcomes such as pain, anxiety, and thirst. The findings support the integration of structured, nurse-led protocols into routine pediatric surgical care to optimize patient recovery.

REGISTRATION: The trial registered in the Clinicaltrial.gov (NCT05962320). The first recruitment was conducted October 2023.