Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient

Peden, Carol 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; Scott, Michael J.

Abstract

Background: This is Part 3 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy using an enhanced recovery after surgery (ERAS) approach. This paper addresses organizational aspects of care. Methods: Experts in 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 were performed for ERAS elements and relevant specific topics. Studies 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 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. Results: Components of organizational aspects of care were considered. Consensus was reached after three rounds of a modified Delphi process. Conclusions: These guidelines are based on best current available evidence for organizational aspects of an ERAS® approach to patients undergoing emergency laparotomy and include discussion of less common aspects of care for the surgical patient, including end-of-life issues. 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

Peden, C. J., Aggarwal, G., Aitken, R. J., Anderson, I. D., Balfour, A., Foss, N. B., …Scott, M. J. (2023). Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient. World Journal of Surgery, 47, 1881-1898. https://doi.org/10.1007/s00268-023-07039-9

• Journal Article Type: Article
• Acceptance Date: Apr 14, 2023
• Online Publication Date: Jun 5, 2023
• Publication Date: 2023-08
• Deposit Date: Apr 24, 2023
• Publicly Available Date: Jun 6, 2024
• Journal: World Journal of Surgery
• Print ISSN: 0364-2313
• Electronic ISSN: 1432-2323
• Peer Reviewed: Peer Reviewed
• Volume: 47
• Pages: 1881-1898
• DOI: https://doi.org/10.1007/s00268-023-07039-9
• Keywords: Enhanced Recovery after Surgery, emergency general surgery, emergency laparotomy, ERAS, perioperative care, sepsis, end of life care
• Public URL: https://nottingham-repository.worktribe.com/output/19994115
• Publisher URL: https://link.springer.com/article/10.1007/s00268-023-07039-9