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Published in: World Journal of Surgery 5/2021

Open Access 01-05-2021 | Laparotomy | Original Scientific Report

Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—Preoperative: Diagnosis, Rapid Assessment and Optimization

Authors: Carol J. Peden, Geeta Aggarwal, Robert J. Aitken, Iain D. Anderson, Nicolai Bang Foss, Zara Cooper, Jugdeep K. Dhesi, W. Brenton French, Michael C. Grant, Folke Hammarqvist, Sarah P. Hare, Joaquim M. Havens, Daniel N. Holena, Martin Hübner, Jeniffer S. Kim, Nicholas P. Lees, Olle Ljungqvist, Dileep N. Lobo, Shahin Mohseni, Carlos A. Ordoñez, Nial Quiney, Richard D. Urman, Elizabeth Wick, Christopher L. Wu, Tonia Young-Fadok, Michael Scott

Published in: World Journal of Surgery | Issue 5/2021

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Abstract

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.
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Metadata
Title
Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—Preoperative: Diagnosis, Rapid Assessment and Optimization
Authors
Carol J. Peden
Geeta Aggarwal
Robert J. Aitken
Iain D. Anderson
Nicolai Bang Foss
Zara Cooper
Jugdeep K. Dhesi
W. Brenton French
Michael C. Grant
Folke Hammarqvist
Sarah P. Hare
Joaquim M. Havens
Daniel N. Holena
Martin Hübner
Jeniffer S. Kim
Nicholas P. Lees
Olle Ljungqvist
Dileep N. Lobo
Shahin Mohseni
Carlos A. Ordoñez
Nial Quiney
Richard D. Urman
Elizabeth Wick
Christopher L. Wu
Tonia Young-Fadok
Michael Scott
Publication date
01-05-2021
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 5/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-021-05994-9

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