SERUM CORTISOL LEVEL IN ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAY AND CONVENTIONAL POSTOPERATIVE CARE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 3, Pages 12116-12123
Abstract
Background:Enhanced Recovery After Surgery (ERAS) is an evidence based multimodal perioperative protocol focused on stress reduction of patients and the early return to normal work by introducing multiple measures such as preoperative patient counseling to reduce patient anxiety and stress , nutrition optimization, standardizing analgesia with restricted use of opioids, minimizing electrolyte and fluid imbalance, using lesser invasive surgical approaches and promoting early ambulation and feeding so that the patient recovers faster, experience less physiological stress, has a shorter hospital stay and have fewer complications. Present study is undertaken to compare the changes in serum cortisol level, a stress hormone, in patients undergoing elective laparoscopic cholecystectomy with ERAS pathway and Conventional postoperative care, not following ERAS pathway.Methods: 50 patients were randomised into 2 groups. 25 patients were in ERAS ( group 1) and 25 patients were in Non ERAS, conventional postoperative care group ( group 2). Samples for serum cortisol level were collected 1 hour and 6 hour after surgery.
Results: Statistically significant reduction in serum cortisol level at 1 hour and 6 hour after surgery was observed in both ERAS pathway group (p=0.001) and conventional postoperative, non ERAS pathway, care group (p=0.000) but between the two groups the difference in reduction of serum cortisol level at 1 hour and 6 hour after surgery is not statistically significant.No statistically significant difference was found in serum cortisol level at 1 hour in both the groups (p = 0.727) and at 6 hour in both the groups (p= 0.352).
Conclusion:
This study could not find any statistically significant difference in postoperative serum cortisol level in ERAS pathway group and conventional postoperative, non ERAS pathway, care group to support the fact that ERAS pathway may result in less postoperative stress.This study however shows that by following ERAS protocol in laparoscopic cholecystectomy, probably, the length of postoperative hospital stay can be reduced.
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