Enhanced Recovery after Emergency Surgery: A Systematic Review

Area of Science:

• Surgical Innovation
• Evidence-Based Medicine
• Patient Recovery Protocols

Background:

• Enhanced Recovery After Surgery (ERAS) protocols have demonstrated benefits in elective procedures.
• The applicability and effectiveness of ERAS in the context of emergency surgery (ES) remain less understood.

Purpose of the Study:

• To critically evaluate the existing scientific evidence on the applicability, safety, and effectiveness of ERAS pathways specifically for emergency surgery patients.

Main Methods:

• A systematic literature search was conducted using PubMed and Cochrane databases for ERAS protocols in emergency settings.
• Four cohort studies and one randomized clinical trial (RCT) were selected for data extraction and analysis.
• Key data points included patient demographics, surgical procedures, ERAS elements utilized, and outcomes such as complications, mortality, length of stay (LOS), and readmission rates.

Main Results:

• Implementation of ERAS protocols in ES involved a substantial number of recommended items (11-18 out of 20).
• ERAS was associated with reduced postoperative complications and shorter LOS compared to conventional care.
• Mortality rates were comparable or lower in ERAS groups, while readmission rates showed variability without statistical significance.

Conclusions:

• ERAS pathways are deemed feasible and safe for emergency surgery, offering generally improved patient outcomes.
• Adaptation of ERAS protocols is crucial due to varying compliance with specific items in ES patients.
• Further research is needed to optimize ERAS pathways for the diverse population undergoing emergency surgery.