721 - BJS Prize entrant: Surgical Research Society of Southern Africa (SRSSA) prize winner: Enhanced Recovery After Trauma Surgery (ERATS): a randomised controlled trial in penetrating abdominal trauma

Abstract Background Enhanced Recovery After Surgery (ERAS) programmes optimise perioperative care by reducing the surgical stress response and accelerating functional recovery. While widely implemented in elective surgery, evidence supporting ERAS in emergency trauma laparotomy remains limited. Patients with penetrating abdominal injuries experience substantial morbidity, and perioperative optimisation may reduce complications and hospital length of stay. This study evaluated a modified Enhanced Recovery After Trauma Surgery (ERATS) protocol in haemodynamically stable patients undergoing emergency laparotomy for penetrating trauma. Methods A single-centre randomised controlled trial was conducted at Groote Schuur Hospital, Cape Town, South Africa (March 2018–December 2022). Adults requiring emergency laparotomy for penetrating abdominal trauma were randomised to ERATS (Group 1) or standard care (Group 2). ERATS elements included early enteral feeding, multimodal opioid-sparing analgesia with a continuous wound infusion catheter, early urinary catheter removal, and mobilisation within 24 h. The primary outcome was hospital length of stay. Secondary outcomes included time to diet tolerance, bowel function, mobilisation, postoperative complications, re-operation, and 30-day mortality. Data were analysed using t-tests, Mann–Whitney U tests, χ² tests, and Cox regression (P < 0.05). Ethical approval was granted (UCT-HREC 379/2018); the trial was registered (NCT03920163). Results Eighty-seven patients were enrolled (42 ERATS, 45 standard). Groups were similar in demographics and injury severity. ERATS patients tolerated liquids earlier (0.3 versus 1 day) and solids sooner (1 versus 2 days; P < 0.001). Time to flatus (2.09 versus 3.04 days; P < 0.001) and stool passage (2.66 versus 3.96 days; P < 0.001) were shorter, and urinary catheters were removed earlier (0.5 versus 2 days; P < 0.001). Median hospital stay was reduced (4 versus 6 days; P = 0.006). Complication, readmission, and mortality rates were comparable. Conclusions A modified ERATS protocol is safe and feasible in penetrating trauma laparotomy, enabling faster recovery and discharge without increased complications. Broader implementation may improve outcomes and resource utilisation in low- and middle-income trauma systems.