Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2—Emergency Laparotomy: Intra- and Postoperative Care

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

Abstract

Background
This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care.

Methods
Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical 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 elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL.

Results
Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process.

Conclusions
These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

Citation

Scott, M. J., Aggarwal, G., Aitken, R. J., Anderson, I. D., Balfour, A., Foss, N. B., …Peden, C. J. (2023). Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2—Emergency Laparotomy: Intra- and Postoperative Care. World Journal of Surgery, 47(8), 1850-1880. https://doi.org/10.1007/s00268-023-07020-6

• Journal Article Type: Article
• Acceptance Date: Mar 28, 2023
• Online Publication Date: Jun 5, 2023
• Publication Date: 2023-08
• Deposit Date: Mar 29, 2023
• Publicly Available Date: Jun 6, 2024
• Journal: World Journal of Surgery
• Print ISSN: 0364-2313
• Electronic ISSN: 1432-2323
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 47
• Issue: 8
• Pages: 1850-1880
• DOI: https://doi.org/10.1007/s00268-023-07020-6
• Public URL: https://nottingham-repository.worktribe.com/output/19001930
• Publisher URL: https://link.springer.com/article/10.1007/s00268-023-07020-6