Hvidovre University Hospital, Copenhagen, Denmark.
Harvard Medical School, Kessler Director, Center for Surgery and Public Health, Brigham and Women's Hospital and Division of Trauma, Burns, Surgical Critical Care, and Emergency Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, Guy's and St Thomas' NHS Foundation Trust, King's College London, Division of Surgery & Interventional Science, University College London, London, UK.
Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA.
Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, UK.
Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA.
Department of Surgery and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.
Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of General & Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, UK.
Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia; Sección de Cirugía de Trauma Y Emergencias, Universidad del Valle, Cali, Colombia.
Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital / Harvard Medical School, Boston, MA, USA.
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Department of Anesthesiology, Critical Care and Pain Medicine-Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA.
Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA.
BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach.
METHODS: Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1-Preoperative Care and Part 2-Intraoperative and Postoperative management. This paper provides guidelines for Part 1.
RESULTS: Twelve components of preoperative care were considered. Consensus was reached after three rounds.
CONCLUSIONS: These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.
Springer, 2021. Vol. 45, p. 1272-1290