Description

Following approval from the Ethical Review Committee (ERC) of Faisalabad Medical University, 96 eligible patients will be enrolled consecutively from the Department of General Surgery, Allied Hospital, Faisalabad. The purpose and procedures of the study will be explained to each eligible patient, and written informed consent will be obtained before enrolment.

Baseline demographic and clinical information, including age, sex, weight, duration of symptoms, comorbidities, ASA physical status, indication for surgery and planned extent of thyroidectomy, will be recorded. A detailed medical and surgical history and physical examination will be performed. Routine preoperative investigations, including haematological, biochemical and thyroid function tests, along with relevant radiological investigations, will be carried out. All patients will undergo preoperative anaesthetic assessment.

Following enrolment, participants will be randomly allocated in a 1:1 ratio to either Group A (ERAS protocol) or Group B (non-ERAS local perioperative regimen). Randomization will be performed using a computer-generated random allocation sequence comprising 48 assignments for each group. Allocation will be concealed using sequentially numbered, opaque, sealed envelopes, which will be opened only after participant enrolment.

Group A will receive a structured Enhanced Recovery After Surgery (ERAS) protocol incorporating preoperative carbohydrate loading, pre-emptive analgesia, optimized anaesthetic and fluid management, local anaesthetic infiltration, avoidance of routine surgical drains, multimodal postoperative analgesia, antiemetic prophylaxis, early oral intake and early mobilization. Postoperative management will also include protocolized monitoring of neck swelling and voice changes, early calcium and parathyroid hormone assessment, and calcium and vitamin D supplementation when indicated.

Group B will receive the conventional non-ERAS local perioperative regimen, including preoperative fasting, standard anaesthetic management, conventional intraoperative fluid administration, routine surgical drain placement, conventional postoperative analgesia, reactive antiemetic treatment, delayed oral intake and mobilization, and routine postoperative monitoring and calcium assessment.

All thyroidectomy procedures will be performed or directly supervised by a surgeon at Senior Registrar level or above, using the standard departmental surgical technique. Following surgery and stabilization in the postoperative recovery area, participants will be transferred to the surgical ward and managed according to their allocated perioperative regimen.

The primary investigator will assess and record the study outcomes in both groups. The exact dates and times of completion of surgery, first postoperative ambulation and hospital discharge will be documented. Time to first ambulation will be calculated in hours from completion of surgery until the participant first gets out of bed and walks, either independently or with assistance. Length of hospital stay will be calculated from completion of surgery until actual hospital discharge and expressed in days.

Routine postoperative clinical assessments, including wound examination and monitoring for surgical and medical complications, will be performed in both groups. The same clinical discharge criteria will be applied to participants in both groups to minimize bias in the assessment of hospital stay. Participants will be discharged once they fulfil the clinical discharge criteria and will receive routine postoperative instructions and follow-up advice.

Postoperative follow-up will continue for four weeks after surgery. All collected information, including demographic characteristics, clinical findings, treatment allocation and postoperative outcomes, will be recorded and analysed using IBM SPSS Statistics version 25.0.