Clinical Trial Summary
ERAS IN TRAUMA Enhanced recovery after surgery (ERAS) or enhanced recovery protocols (ERP) is
a concept first described by Kehlet in the early 1990s .Since its introduction, ERAS
protocols have been successfully used in elective gastrointestinal surgery (colorectal,
hepatobiliary and gastric), and there has been widespread acceptance and implementation in
other surgical disciplines including urology, vascular , thoracic surgery and orthopaedics.
The approach employs a multimodal perioperative care pathway designed to attenuate the
surgical stress response and accelerate postoperative recovery .
These benefits should be easily transferrable to the trauma patient population, if not
greater, since trauma patients are generally younger, fitter and metabolically stable.
Trauma centres in developing countries constantly battle with reduced bed availability and
restricted health care budgets. Optimization of health care practice is therefore urgent,
particularly in trauma surgery.
Penetrating abdominal trauma is a major cause of morbidity and mortality in large urban
trauma centres. It accounts for a significant number of hospital admissions and consumes a
large portion of the health care budget.
In the trauma patient, the aim is to maintain the 'pre- injury' physiological status.
Improving patient outcomes with reduced morbidity and early hospital discharge reduces the
cost of treating these patients .
The small pilot study by Moydien et al., showed that ERPS can be successfully implemented
with significant shorter hospital stays without any increase in postoperative complications
in a select group of trauma patients undergoing emergency laparotomy for isolated penetrating
abdominal trauma. Furthermore, the study showed that ERPS can also be applied to patients
undergoing emergency surgery. Given the fact that penetrating abdominal trauma remains a
substantial burden of disease, especially in developing countries such as South Africa, this
proven approach to patient care in elective surgery can now be safely employed in the trauma
and emergency setting.
Penetrating abdominal trauma remains a substantial burden of disease, especially in
developing countries such as South Africa, and especially the Western Cape, where we have
seen an increase in the number of trauma patients being treated for penetrating injuries at
our level 1 centre. This has in turn led to severe constraints on the available resources,
with the trauma ward often at maximum capacity with delayed discharges due to poor
ambulation, post operative complications, and delay in return to enteral feeding.
Currently there is no randomized controlled study in the trauma literature, evaluating
enhanced recovery after trauma procedures .It is our hypothesis to that implementing an
"ERATS" protocol , will lead to a reduction in morbidity, reduction in hospital stay , with a
subsequent decrease in costs. This will allow us to implement this as a new standard protocol
, and thus change the current practice in stable penetrating trauma patients undergoing
explorative laparotomy in our unit, nationally and worldwide.
