Effect of enhanced recovery after surgery protocol based care on patient outcomes in children with acute appendicitis

Purpose: This study was conducted to evaluate the safety, applicability and the effect of the care based on the enhanced recovery after surgery protocol (mERAS) on patient outcomes in children diagnosed with acute appendicitis and planned appendectomy and their parents. Method: The study was conducted in a prospective, randomized controlled trial design between October 2023 and May 2024 with children aged 6-18 years diagnosed with appendicitis. The population of the study consisted of 82 children and the sample consisted of 69 children (mERAS group: 33, standard care group: 36). Although the primary endpoint was the duration of postoperative hospital stay, time to mobilization, time to recovery of the gastrointestinal tract, time to oral intake, development of postoperative complications and readmission to hospital were evaluated with appropriate statistical analyses. Results: Data of 33 patients in the intervention group and 36 patients in the control group were analyzed. Postoperative hospital stay was significantly shorter in the intervention group (28,17±11,47 h) compared to the standard care group (38,01±12,13 h) (p=0,001). Readmission to the hospital was similar between the groups (p=0,559), and the times of first postoperative mobilization, first flatus, first defecation, and transition to regimen 1 and regimen 2 were shorter in the intervention group than in the control group (p<0,05). It was determined that the type of complicated appendicitis increased the risk of prolonged hospital stay (p=0,006), whereas care practices based on the mERAS protocol decreased it (p=0,004). Conclusion: Care based on the mERAS protocol in pediatric appendectomy may decrease the length of hospital stay without increasing post-discharge readmissions. It shows that the use of ERAS protocols in pediatric appendectomy is safe and feasible.