Adapted enhanced recovery after surgery protocol versus conventional protocol in emergency laparotomy - a prospective interventional study

Background: Emergency laparotomy remains a high-risk procedure with significant post-operative morbidity and mortality, especially in resource-limited settings. Conventional perioperative protocols are associated with prolonged recovery and higher complication rates. Adapted enhanced recovery after surgery (ERAS) protocols offer a multimodal, evidence-based approach designed to accelerate recovery and improve outcomes. Aims and Objectives: The aim of the study was to evaluate the effectiveness of an adapted ERAS protocol compared to conventional care in patients undergoing emergency laparotomy. Materials and Methods: This prospective interventional study enrolled 100 adult patients at a tertiary care center, divided into two groups of 50 each. Group A received the adapted ERAS protocol emphasizing early mobilization, non-opioid analgesia, and early oral intake. Group B followed conventional care. Recovery milestones, pain scores, complications, and length of hospital stay were recorded and statistically analyzed. Results: The ERAS group demonstrated significantly earlier recovery milestones, including time to flatus (2.52±0.99 vs. 3.40±1.79 days), stool, oral intake, and ambulation. Hospital stay was shorter in the ERAS group (6.56±1.95 vs. 8.08±2.63 days, P=0.003). Complication rates, including nausea, paralytic ileus, and chest infections, were significantly lower. Pain scores on post-operative days 1, 3, and 5 were consistently reduced in the ERAS group. However, nasogastric tube reinsertion was more frequent in the ERAS cohort. Conclusion: Adapted ERAS protocols in emergency laparotomy significantly improve recovery, reduce complications, and shorten hospital stay without compromising safety. Their integration into emergency surgical care is both feasible and beneficial.