Implementation of enhanced recovery after surgery (ERAS) protocols in elderly patients undergoing emergency surgery for perforated peptic ulcer: a comparative analysis

BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols are well-established in elective surgery, yet their role in emergency procedures remains underexplored - particularly in the elderly, a uniquely vulnerable subgroup. This study presents the first focused comparative analysis evaluating ERAS outcomes in elderly patients undergoing emergency surgery for perforated peptic ulcer (PPU). METHODS: This retrospective comparative study analyzed 137 elderly patients (≥ 60 years) who underwent emergency surgery for PPU from August 2020 to July 2024. Patients were divided into: ERAS group (n = 67) and conventional group (n = 70), based on their perioperative protocol of management. Primary outcomes included postoperative functional recovery parameters. Secondary outcomes encompassed postoperative complications, pain scores, length of hospital stay and readmission rates. RESULTS: The ERAS group demonstrated significantly faster functional recovery across multiple parameters: earlier bowel movement (1.21 ± 0.34 vs. 2.20 ± 0.57 days, p = 0.008), faster mobilization (1.26 ± 0.17vs 3.51 ± 0.60 days, p < 0.001), and shorter hospital stay (5.24 ± 0.57 vs. 7.03 ± 2.09 days, p = 0.001). Pain control was superior in the ERAS group, with consistently lower VAS scores and reduced opioid consumption (8.49 ± 0.59 vs. 18.73 ± 0.72 mg, p = 0.001). Notably, postoperative nausea and vomiting were significantly reduced (22.4% vs. 41.8%, p = 0.013). Complication rates were comparable between groups, with no increase in readmission and reoperation rates, suggesting the safety of ERAS implementation. CONCLUSION: This focused analysis provides evidence that ERAS protocols can be safely and effectively implemented in elderly patients undergoing emergency PPU repair, resulting in accelerated recovery, improved pain control, and reduced hospital stay without compromising safety. These findings challenge traditional conservative approaches to perioperative care in elderly emergency surgery patients. However, our findings primarily apply to a relatively stable 'young-elderly' subgroup and may not reflect outcomes in frailer or critically ill elderly populations.