An interventional study of Nursing-Led Enhanced Recovery After Surgery (ERAS) Protocol and Routine Postoperative Care in Enhanced Recovery After Surgery (ERAS) Protocol, sponsored by Al-Zaytoonah University of Jordan. Completed at 1 site in Egypt. Open to participants aged 18 Years to 65 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-11-05.
Sponsored by Al-Zaytoonah University of Jordan · Not applicable, Interventional, and Supportive care
This study evaluates the effect of a nursing-led Enhanced Recovery After Surgery (ERAS) protocol on recovery among adults undergoing emergency laparotomy. A total of 120 eligible patients aged 18-65 years were randomly assigned to either a study group receiving the nursing-led ERAS protocol in addition to routine postoperative care or a control group receiving routine postoperative care alone. The protocol includes respiratory care, pain and nausea management, early mobilization, nutritional support, prevention of postoperative complications, catheter and drain management, psychosocial support, and patient education and discharge planning. Postoperative pain, recovery milestones, complications, hospital readmission, length of hospital stay, and satisfaction with nursing care are assessed.
Emergency laparotomy is a major surgical procedure performed for acute abdominal conditions and is associated with postoperative pain, delayed mobilization and gastrointestinal recovery, postoperative complications, prolonged hospitalization, and readmission. Enhanced Recovery After Surgery (ERAS) is an evidence-based approach that integrates multiple perioperative strategies to support recovery. This study evaluates a nursing-led ERAS protocol among patients undergoing emergency laparotomy.
The study used a randomized controlled trial design with two parallel groups. Eligible participants were randomly allocated in a 1:1 ratio using a computer-generated randomization sequence. The study was conducted in the General Surgical Unit at Menoufia University Hospital, Egypt. The protocol was developed based on ERAS Society recommendations for emergency laparotomy and contemporary evidence regarding enhanced recovery interventions in abdominal surgery.
Before implementation, assigned staff nurses received orientation regarding the objectives, components, and procedures of the nursing-led ERAS protocol to promote standardized delivery and intervention fidelity. The protocol was individualized according to each patient's clinical condition, hemodynamic stability, tolerance to activity and oral intake, and physician orders. Adherence was monitored daily using an ERAS implementation checklist, direct observation, and review of patient records.
Postoperative pain was assessed during the first three postoperative days using the Numeric Pain Rating Scale. Recovery outcomes included postoperative mobilization, nutritional and gastrointestinal recovery, postoperative complications, length of hospital stay, and hospital readmission within 30 days after discharge. Patient satisfaction with nursing care was assessed before discharge using the Patient Satisfaction with Nursing Care Quality Questionnaire.
Outcome assessment was performed by a trained nurse who was not involved in delivering the intervention and was blinded to participants' group allocation. The same standardized assessment procedures and instruments were used for participants in both groups to minimize measurement bias. Written informed consent was obtained before enrollment, and the study received ethical approval from the Ethical and Research Committee of the Faculty of Nursing, Menoufia University (Approval No. 133).
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Exclusion Criteria:
Participants received a nursing-led Enhanced Recovery After Surgery (ERAS) protocol in addition to routine postoperative care following emergency laparotomy. The protocol included eight domains: respiratory care and prevention of pulmonary complications; pain and postoperative nausea and vomiting management; early mobilization and venous thromboembolism prevention; nutritional support and gastrointestinal recovery; monitoring and prevention of postoperative complications; catheter and drain management; delirium prevention and psychosocial support; and patient education, discharge planning, and follow-up. The protocol was individualized according to each patient's clinical condition, hemodynamic stability, and tolerance, and was implemented throughout hospitalization until discharge. Compliance was monitored daily.
Behavioral: Nursing-Led Enhanced Recovery After Surgery (ERAS) Protocol
Participants received routine postoperative nursing care according to the hospital's standard policy without the Nursing-Led ERAS protocol. Routine medical and nursing management continued throughout hospitalization.
Other: Routine Postoperative Care
A structured nursing-led ERAS protocol consisting of eight domains: respiratory care, pain and PONV management, early mobilization and VTE prevention, nutritional and gastrointestinal recovery, complication prevention, catheter and drain management, delirium prevention and psychosocial support, and patient education, discharge planning, and follow-up. The protocol was provided in addition to routine postoperative care throughout hospitalization.
Routine postoperative nursing care provided according to the hospital's standard policy.
Postoperative Pain Intensity
Postoperative pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), an 11-point scale ranging from 0 (no pain) to 10 (worst possible pain). Mean pain scores were compared between the study and control groups.
Time frame: Postoperative Days 1, 2, and 3.
Time to First Passage of Flatus
The time interval, measured in hours, from the end of emergency laparotomy surgery to the first documented passage of intestinal flatus. The time will be recorded from nursing documentation and compared between the study and control groups.
Time frame: From the end of surgery until the first documented passage of flatus or hospital discharge, whichever occurs first, during the postoperative hospitalization.
Time to First Bowel Movement
The time interval, measured in hours, from the end of emergency laparotomy surgery to the first documented bowel movement. The time will be recorded from nursing documentation and compared between the study and control groups.
Time frame: From the end of surgery until the first documented bowel movement or hospital discharge, whichever occurs first, during the postoperative hospitalization.
Length of Hospital Stay
Total duration of hospitalization, measured in days from hospital admission until hospital discharge. The duration will be calculated from admission and discharge dates documented in the patient's medical record and compared between the study and control groups.
Time frame: From the date of hospital admission until the date of hospital discharge during the index hospitalization.
Plan to share: Yes — De-identified individual participant data (IPD) underlying the results reported in this study will be shared upon reasonable request. The data will include sociodemographic and clinical characteristics, postoperative pain scores, postoperative recovery milestones, complications, hospital readmission, length of hospital stay, and patient satisfaction with nursing care. All shared data will be de-identified to ensure participants' confidentiality and privacy.
Supporting information: Study protocol
Time frame: De-identified individual participant data and selected supporting documents will be available beginning 12 months after publication of the study results and will remain available for 3 years thereafter.
Access criteria: Qualified researchers may request access to the de-identified individual participant data by contacting the corresponding author, Adel M. Al Jawfi (adel@tu.edu.ye). Requests must include a reasonable research proposal explaining the intended use of the data. All requests will be reviewed by the corresponding author. Access will be granted upon approval of the request and subject to applicable ethical, confidentiality, and data protection requirements.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
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Al-Zaytoonah University of Jordan