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

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  • 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
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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.

Original languageEnglish
JournalWorld Journal of Surgery
Volume45
Issue number5
Pages (from-to)1272-1290
Number of pages19
ISSN0364-2313
DOIs
Publication statusPublished - May 2021

Bibliographical note

Publisher Copyright:
© 2021, The Author(s).

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

ID: 64083019