Adapted ERAS Pathway vs. Standard Care in Patients with Perforated Duodenal Ulcer—a Randomized Controlled Trial
Objectives The objective of this study was to evaluate the feasibility and efficacy of ERAS pathways in patients undergoing emergency simple closure of perforated duodenal ulcer (PDU). Methods This single-center, prospective, open-labeled, superiority, RCT was carried out from August 2014 to July 20...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2018, Vol.22 (1), p.107-116 |
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| creator | Mohsina, Subair Shanmugam, Dasarathan Sureshkumar, Sathasivam Kundra, Pankaj Mahalakshmy, T. Kate, Vikram |
| description | Objectives
The objective of this study was to evaluate the feasibility and efficacy of ERAS pathways in patients undergoing emergency simple closure of perforated duodenal ulcer (PDU).
Methods
This single-center, prospective, open-labeled, superiority, RCT was carried out from August 2014 to July 2016. Patients of PDU undergoing open simple closure were randomized preoperatively in 1:1 ratio into standard care and adapted ERAS group. Patients with refractory shock, ASA class ≥3, and perforation size ≥1 cm were excluded. Primary outcome was the length of hospitalization (LOH). Secondary outcomes were functional recovery parameters and morbidity.
Results
Forty-nine and 50 patients were included in standard care and ERAS group, respectively. Patients in ERAS group had a significantly early functional recovery (days) for the time to first flatus (1.47 ± 0.18;
p
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| doi_str_mv | 10.1007/s11605-017-3474-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1914289867</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1914289867</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-537248d4f497166b5367c998fa1c68b66594ffa11ef6202862e6884340734a503</originalsourceid><addsrcrecordid>eNp1kctKxDAUhoMojrcHcCMBN26quV-Ww3gFwcELuAuZNtUOnWYmaRVd-RA-oU9iyqiI4CY54Xz_fzj5AdjF6BAjJI8ixgLxDGGZUSZZRlbABlaSZkwQsZpqpHFGOL8fgM0YpyiBCKt1MCBKcEqo3gCLYWHnrSvgyfXwBo5t-_hsX-BTPIQ3rW0KGwo4ssHBqumblWvaCJ-r9hGOXSh9sL30uPOFa2wN7-rchY-3dwuvk9bPqtfUHfmmDb6uU3kbKltvg7XS1tHtfN1b4O705HZ0nl1enV2MhpdZTiVpM55OpgpWMi2xEBNOhcy1VqXFuVATIbhmZXpgVwqC0kLECaUYZUhSZjmiW-Bg6TsPftG52JpZFXNX17ZxvosGa8yI0krIhO7_Qae-C2mjnpJacsWUThReUnnwMQZXmnmoZja8GIxMn4dZ5mHSN5s-D0OSZu_LuZvMXPGj-A4gAWQJxNRqHlz4Nfpf10-LoJQ3</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1979758489</pqid></control><display><type>article</type><title>Adapted ERAS Pathway vs. Standard Care in Patients with Perforated Duodenal Ulcer—a Randomized Controlled Trial</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Mohsina, Subair ; Shanmugam, Dasarathan ; Sureshkumar, Sathasivam ; Kundra, Pankaj ; Mahalakshmy, T. ; Kate, Vikram</creator><creatorcontrib>Mohsina, Subair ; Shanmugam, Dasarathan ; Sureshkumar, Sathasivam ; Kundra, Pankaj ; Mahalakshmy, T. ; Kate, Vikram</creatorcontrib><description><![CDATA[Objectives
The objective of this study was to evaluate the feasibility and efficacy of ERAS pathways in patients undergoing emergency simple closure of perforated duodenal ulcer (PDU).
Methods
This single-center, prospective, open-labeled, superiority, RCT was carried out from August 2014 to July 2016. Patients of PDU undergoing open simple closure were randomized preoperatively in 1:1 ratio into standard care and adapted ERAS group. Patients with refractory shock, ASA class ≥3, and perforation size ≥1 cm were excluded. Primary outcome was the length of hospitalization (LOH). Secondary outcomes were functional recovery parameters and morbidity.
Results
Forty-nine and 50 patients were included in standard care and ERAS group, respectively. Patients in ERAS group had a significantly early functional recovery (days) for the time to first flatus (1.47 ± 0.18;
p
< 0.001), first stool (2.25 ± 0.20;
p
< 0.001), first fluid diet (2.72 ± 0.38;
p
< 0.001), and solid diet (3.70 ± 0.44;
p
< 0.001). LOH in ERAS group was significantly shorter (mean difference of 4.41 ± 0.64 days;
p
< 0.001). There was a significant reduction in postoperative morbidity such as superficial SSI (RR 0.35,
p
= 0.02), postoperative nausea and vomiting (RR 0.28,
p
< 0.0001), and pulmonary complications (RR 0.24,
p
= 0.04) in the ERAS vs. standard care group with similar leak rates (1/50 vs.2/49).
Conclusion
ERAS pathways are safe and feasible in select patients undergoing emergency simple closure of PDU.]]></description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-017-3474-2</identifier><identifier>PMID: 28653239</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2017 SSAT Plenary Presentation ; Adult ; Defecation ; Drinking ; Duodenal Ulcer - complications ; Duodenal Ulcer - surgery ; Eating ; Feasibility Studies ; Female ; Gastroenterology ; Gastrointestinal surgery ; Humans ; Length of Stay ; Lung Diseases - etiology ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Peptic Ulcer Perforation - etiology ; Peptic Ulcer Perforation - surgery ; Perioperative Care - adverse effects ; Perioperative Care - methods ; Postoperative Nausea and Vomiting - etiology ; Prospective Studies ; Recovery (Medical) ; Recovery of Function ; Surgery ; Surgical Wound Infection - etiology ; Time Factors ; Ulcers</subject><ispartof>Journal of gastrointestinal surgery, 2018, Vol.22 (1), p.107-116</ispartof><rights>The Society for Surgery of the Alimentary Tract 2017</rights><rights>Journal of Gastrointestinal Surgery is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-537248d4f497166b5367c998fa1c68b66594ffa11ef6202862e6884340734a503</citedby><cites>FETCH-LOGICAL-c372t-537248d4f497166b5367c998fa1c68b66594ffa11ef6202862e6884340734a503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-017-3474-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-017-3474-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28653239$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mohsina, Subair</creatorcontrib><creatorcontrib>Shanmugam, Dasarathan</creatorcontrib><creatorcontrib>Sureshkumar, Sathasivam</creatorcontrib><creatorcontrib>Kundra, Pankaj</creatorcontrib><creatorcontrib>Mahalakshmy, T.</creatorcontrib><creatorcontrib>Kate, Vikram</creatorcontrib><title>Adapted ERAS Pathway vs. Standard Care in Patients with Perforated Duodenal Ulcer—a Randomized Controlled Trial</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description><![CDATA[Objectives
The objective of this study was to evaluate the feasibility and efficacy of ERAS pathways in patients undergoing emergency simple closure of perforated duodenal ulcer (PDU).
Methods
This single-center, prospective, open-labeled, superiority, RCT was carried out from August 2014 to July 2016. Patients of PDU undergoing open simple closure were randomized preoperatively in 1:1 ratio into standard care and adapted ERAS group. Patients with refractory shock, ASA class ≥3, and perforation size ≥1 cm were excluded. Primary outcome was the length of hospitalization (LOH). Secondary outcomes were functional recovery parameters and morbidity.
Results
Forty-nine and 50 patients were included in standard care and ERAS group, respectively. Patients in ERAS group had a significantly early functional recovery (days) for the time to first flatus (1.47 ± 0.18;
p
< 0.001), first stool (2.25 ± 0.20;
p
< 0.001), first fluid diet (2.72 ± 0.38;
p
< 0.001), and solid diet (3.70 ± 0.44;
p
< 0.001). LOH in ERAS group was significantly shorter (mean difference of 4.41 ± 0.64 days;
p
< 0.001). There was a significant reduction in postoperative morbidity such as superficial SSI (RR 0.35,
p
= 0.02), postoperative nausea and vomiting (RR 0.28,
p
< 0.0001), and pulmonary complications (RR 0.24,
p
= 0.04) in the ERAS vs. standard care group with similar leak rates (1/50 vs.2/49).
Conclusion
ERAS pathways are safe and feasible in select patients undergoing emergency simple closure of PDU.]]></description><subject>2017 SSAT Plenary Presentation</subject><subject>Adult</subject><subject>Defecation</subject><subject>Drinking</subject><subject>Duodenal Ulcer - complications</subject><subject>Duodenal Ulcer - surgery</subject><subject>Eating</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Lung Diseases - etiology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Peptic Ulcer Perforation - etiology</subject><subject>Peptic Ulcer Perforation - surgery</subject><subject>Perioperative Care - adverse effects</subject><subject>Perioperative Care - methods</subject><subject>Postoperative Nausea and Vomiting - etiology</subject><subject>Prospective Studies</subject><subject>Recovery (Medical)</subject><subject>Recovery of Function</subject><subject>Surgery</subject><subject>Surgical Wound Infection - etiology</subject><subject>Time Factors</subject><subject>Ulcers</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kctKxDAUhoMojrcHcCMBN26quV-Ww3gFwcELuAuZNtUOnWYmaRVd-RA-oU9iyqiI4CY54Xz_fzj5AdjF6BAjJI8ixgLxDGGZUSZZRlbABlaSZkwQsZpqpHFGOL8fgM0YpyiBCKt1MCBKcEqo3gCLYWHnrSvgyfXwBo5t-_hsX-BTPIQ3rW0KGwo4ssHBqumblWvaCJ-r9hGOXSh9sL30uPOFa2wN7-rchY-3dwuvk9bPqtfUHfmmDb6uU3kbKltvg7XS1tHtfN1b4O705HZ0nl1enV2MhpdZTiVpM55OpgpWMi2xEBNOhcy1VqXFuVATIbhmZXpgVwqC0kLECaUYZUhSZjmiW-Bg6TsPftG52JpZFXNX17ZxvosGa8yI0krIhO7_Qae-C2mjnpJacsWUThReUnnwMQZXmnmoZja8GIxMn4dZ5mHSN5s-D0OSZu_LuZvMXPGj-A4gAWQJxNRqHlz4Nfpf10-LoJQ3</recordid><startdate>2018</startdate><enddate>2018</enddate><creator>Mohsina, Subair</creator><creator>Shanmugam, Dasarathan</creator><creator>Sureshkumar, Sathasivam</creator><creator>Kundra, Pankaj</creator><creator>Mahalakshmy, T.</creator><creator>Kate, Vikram</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>2018</creationdate><title>Adapted ERAS Pathway vs. Standard Care in Patients with Perforated Duodenal Ulcer—a Randomized Controlled Trial</title><author>Mohsina, Subair ; Shanmugam, Dasarathan ; Sureshkumar, Sathasivam ; Kundra, Pankaj ; Mahalakshmy, T. ; Kate, Vikram</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-537248d4f497166b5367c998fa1c68b66594ffa11ef6202862e6884340734a503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>2017 SSAT Plenary Presentation</topic><topic>Adult</topic><topic>Defecation</topic><topic>Drinking</topic><topic>Duodenal Ulcer - complications</topic><topic>Duodenal Ulcer - surgery</topic><topic>Eating</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Lung Diseases - etiology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Peptic Ulcer Perforation - etiology</topic><topic>Peptic Ulcer Perforation - surgery</topic><topic>Perioperative Care - adverse effects</topic><topic>Perioperative Care - methods</topic><topic>Postoperative Nausea and Vomiting - etiology</topic><topic>Prospective Studies</topic><topic>Recovery (Medical)</topic><topic>Recovery of Function</topic><topic>Surgery</topic><topic>Surgical Wound Infection - etiology</topic><topic>Time Factors</topic><topic>Ulcers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mohsina, Subair</creatorcontrib><creatorcontrib>Shanmugam, Dasarathan</creatorcontrib><creatorcontrib>Sureshkumar, Sathasivam</creatorcontrib><creatorcontrib>Kundra, Pankaj</creatorcontrib><creatorcontrib>Mahalakshmy, T.</creatorcontrib><creatorcontrib>Kate, Vikram</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mohsina, Subair</au><au>Shanmugam, Dasarathan</au><au>Sureshkumar, Sathasivam</au><au>Kundra, Pankaj</au><au>Mahalakshmy, T.</au><au>Kate, Vikram</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adapted ERAS Pathway vs. Standard Care in Patients with Perforated Duodenal Ulcer—a Randomized Controlled Trial</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2018</date><risdate>2018</risdate><volume>22</volume><issue>1</issue><spage>107</spage><epage>116</epage><pages>107-116</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract><![CDATA[Objectives
The objective of this study was to evaluate the feasibility and efficacy of ERAS pathways in patients undergoing emergency simple closure of perforated duodenal ulcer (PDU).
Methods
This single-center, prospective, open-labeled, superiority, RCT was carried out from August 2014 to July 2016. Patients of PDU undergoing open simple closure were randomized preoperatively in 1:1 ratio into standard care and adapted ERAS group. Patients with refractory shock, ASA class ≥3, and perforation size ≥1 cm were excluded. Primary outcome was the length of hospitalization (LOH). Secondary outcomes were functional recovery parameters and morbidity.
Results
Forty-nine and 50 patients were included in standard care and ERAS group, respectively. Patients in ERAS group had a significantly early functional recovery (days) for the time to first flatus (1.47 ± 0.18;
p
< 0.001), first stool (2.25 ± 0.20;
p
< 0.001), first fluid diet (2.72 ± 0.38;
p
< 0.001), and solid diet (3.70 ± 0.44;
p
< 0.001). LOH in ERAS group was significantly shorter (mean difference of 4.41 ± 0.64 days;
p
< 0.001). There was a significant reduction in postoperative morbidity such as superficial SSI (RR 0.35,
p
= 0.02), postoperative nausea and vomiting (RR 0.28,
p
< 0.0001), and pulmonary complications (RR 0.24,
p
= 0.04) in the ERAS vs. standard care group with similar leak rates (1/50 vs.2/49).
Conclusion
ERAS pathways are safe and feasible in select patients undergoing emergency simple closure of PDU.]]></abstract><cop>New York</cop><pub>Springer US</pub><pmid>28653239</pmid><doi>10.1007/s11605-017-3474-2</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1091-255X |
| ispartof | Journal of gastrointestinal surgery, 2018, Vol.22 (1), p.107-116 |
| issn | 1091-255X 1873-4626 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1914289867 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | 2017 SSAT Plenary Presentation Adult Defecation Drinking Duodenal Ulcer - complications Duodenal Ulcer - surgery Eating Feasibility Studies Female Gastroenterology Gastrointestinal surgery Humans Length of Stay Lung Diseases - etiology Male Medicine Medicine & Public Health Middle Aged Peptic Ulcer Perforation - etiology Peptic Ulcer Perforation - surgery Perioperative Care - adverse effects Perioperative Care - methods Postoperative Nausea and Vomiting - etiology Prospective Studies Recovery (Medical) Recovery of Function Surgery Surgical Wound Infection - etiology Time Factors Ulcers |
| title | Adapted ERAS Pathway vs. Standard Care in Patients with Perforated Duodenal Ulcer—a Randomized Controlled Trial |
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