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International Journal of Surgery Science
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International Journal of Surgery Science
Vol. 5, Issue 2, Part B (2021)

Enhanced recovery after elective visceral surgery in countries with limited resources: our experience at the centre médical diamant of Lubumbashi (CMDL)/Democratic Republic of the Congo

Author(s): David David Mutombo Mwembo, Rivain Iteke Féfé, Augustin Kibonge Mukakala, Eric Wakunga Unen, Dimitri Kanyanda Nafatalewa, Donatien Polepole Kahiya, Patrick Mubinda Kiopin, Roger Munan Mwazaz, Vincent de Paul Kaoma Cabala, Lucien Somwa Muhemedi, David Mbayo Nyembo, Sandra Sagboze Zalambo, Sebastien Mbuyi Musanzayi and Willy Arung Kalau Mutombo Mwembo, Rivain Iteke Féfé, Augustin Kibonge Mukakala, Eric Wakunga Unen, Dimitri Kanyanda Nafatalewa, Donatien Polepole Kahiya, Patrick Mubinda Kiopin, Roger Munan Mwazaz, Vincent de Paul Kaoma Cabala, Lucien Somwa Muhemedi, David Mbayo Nyembo, Sandra Sagboze Zalambo, Sebastien Mbuyi Musanzayi and Willy Arung Kalau
Abstract:
Introduction: Enhanced recovery after surgery (ERAS) was introduced by H. Khelet and his team in colorectal surgery in 1990, with the aim of reducing the rate of postoperative complications and the length of stay. This illustration of evidence-based medicine is a multimodal management strategy aimed at minimizing the impact of perioperative stress on the patient and thus reducing postoperative risks. The aim of this study was to implement this program, to assess its impact on postoperative morbi-mortality and health care costs in order to popularize it among surgeons, anesthesiologists and their collaborators.
Patients and methods: This was a descriptive and interventional evaluative study conducted at the Centre Médical Diamant of Lubumbashi (CMDL) in the Democratic Republic of the Congo, from September 1, 2019 to October 30, 2020. The sample was for convenience, not probabilistic, including 49 operated for elective visceral surgery at Diamond Medical Center during our study period. Our data were entered and analyzed using the epi info 2011 software. The results are presented in the form of tables and sentences.
Results: The age of the patients ranged from 1 to 65 years with a mean of 31 ± 15 years. The female sex was the most represented with a sex ratio of 1.27. 9.39% of patients were ASA I and 14 patients, or 28.57% ASA II. For gynecology and obstetrics, scheduled cesarean section was the most common intervention (7 out of 49), i.e. 14.29%. In general surgery, the inguinal hernia was operated on in 16.33%. General anesthesia was performed in 57.14% of cases versus 42.86% for spinal anesthesia. The evaluation of discharge from the operating room was made according to the modified Aldrete and Bromage score, respectively. Among the 21 items in our ERAS program, 19 were implemented in all patients, for an overall implementation rate of 90.48%. According to the Clavien Dindo classification, all patients operated on under the ERAS protocol in our series had no postoperative morbi-mortality. All the operated on in our series had no postoperative morbi-mortality according to the Clavien and Dindo classification. Analgesia extended from 1-5 days depending on the patient, with a mean duration of administration of 3 ± 1 day. The duration and type of analgesia were assessed by quantifying pain using the virtual analog scale (VAS) in 100% of cases. All patients had undergone a post-hospitalization audit, systematically on the 3rd day of discharge by phone call. The average length of hospital stay was 4 days ± 3.55.10% of patients had a single day of postoperative hospitalization.
Conclusion: The Enhanced recovery after surgery (ERAS) can indeed be applied in our countries with limited resources with all the expected benefits.
Pages: 77-83  |  323 Views  142 Downloads
How to cite this article:
David David Mutombo Mwembo, Rivain Iteke Féfé, Augustin Kibonge Mukakala, Eric Wakunga Unen, Dimitri Kanyanda Nafatalewa, Donatien Polepole Kahiya, Patrick Mubinda Kiopin, Roger Munan Mwazaz, Vincent de Paul Kaoma Cabala, Lucien Somwa Muhemedi, David Mbayo Nyembo, Sandra Sagboze Zalambo, Sebastien Mbuyi Musanzayi, Willy Arung Kalau Mutombo Mwembo, Rivain Iteke Féfé, Augustin Kibonge Mukakala, Eric Wakunga Unen, Dimitri Kanyanda Nafatalewa, Donatien Polepole Kahiya, Patrick Mubinda Kiopin, Roger Munan Mwazaz, Vincent de Paul Kaoma Cabala, Lucien Somwa Muhemedi, David Mbayo Nyembo, Sandra Sagboze Zalambo, Sebastien Mbuyi Musanzayi, Willy Arung Kalau. Enhanced recovery after elective visceral surgery in countries with limited resources: our experience at the centre médical diamant of Lubumbashi (CMDL)/Democratic Republic of the Congo. Int J Surg Sci 2021;5(2):77-83. DOI: https://doi.org/10.33545/surgery.2021.v5.i2b.665
International Journal of Surgery Science