Implementing enhanced recovery protocol to improve trauma laparotomy outcomes: A single-center pilot study

Abstract

Introduction

Enhanced Recovery Protocols (ERPs) are designed to improve postoperative recovery. Since their inception, ERPs have become the standard of care across multiple surgical specialities, with numerous guidelines established for elective procedures. While ERP principles have been extended to emergency abdominal surgeries, their application in trauma laparotomy remains limited. This study details the development of an ERP tailored for trauma laparotomy patients and evaluates outcomes following its implementation.

Methods

A multidisciplinary team developed an ERP, termed the Trauma Laparotomy Care Pathway (TLCP), grounded in best available evidence and adapted to our clinical setting through a rigorous consensus process. Following implementation, we conducted a single-center pilot study as part of a quality improvement initiative, comparing trauma laparotomy patients managed with TLCP from February to July 2024 to a historical cohort as the baseline group. We analyzed adherence to five key postoperative components and assessed impacts on postoperative outcomes.

Results

In the first six months post-implementation, 31 patients were managed using TLCP. The median age was 32.0 years, with males comprising 87.1 % of patients. Stab wounds were the most frequent injury mechanism, followed by motor vehicle-related accidents and falls. Isolated abdominal injuries accounted for 64.5 % of cases. Adherence to key pathway components ranged from 54.5 % to 67.7 %. The hospital length of stay was significantly shorter for the TLCP group, showing a two-day reduction compared to the historical cohort (4.0 days [3.5, 6.5] vs 6.0 days [4.0, 10.0], p = 0.002). There was no significant difference in in-hospital complications or 30-day readmission rates between the groups.

Conclusion

Following TLCP implementation, a reduction in hospital length of stay was observed, with no apparent increase in complications or 30-day readmission rates. These findings suggest that ERPs may be applicable to selected trauma laparotomy patients, with the potential to improved clinical outcomes. Further large-scale studies are warranted to validate these results.