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Challenges in optimising recovery after emergency laparotomy.

N B Foss1, H Kehlet2

  • 1Department of Anaesthesiology, Hvidovre University Hospital, Hvidovre, Denmark.

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|January 7, 2020
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Summary

Standardised care pathways for emergency laparotomy are inadequate. Future research should focus on procedure-specific enhanced recovery protocols to reduce patient morbidity and mortality.

Keywords:
analgesiaemergency laparotomyenhanced recoveryfluid managementperi-operative

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Area of Science:

  • Surgical pathway optimization
  • Peri-operative care research
  • Emergency abdominal surgery

Background:

  • Standardised peri-operative care pathways for emergency laparotomy are inadequate, leading to high morbidity and mortality.
  • Current 'rescue' pathways focus on early intervention and specialist involvement but lack procedure-specific detail.
  • Enhanced recovery after surgery (ERAS) in elective procedures demonstrates significant benefits.

Purpose of the Study:

  • To highlight the inadequacy of current emergency laparotomy care pathways.
  • To identify the need for research into procedure- and pathology-specific enhanced recovery protocols.
  • To bridge the gap between 'rescue' interventions and comprehensive enhanced recovery.

Main Methods:

  • Review of existing literature on peri-operative care for emergency laparotomy.
  • Analysis of the heterogeneity within emergency laparotomy patient groups (obstruction vs. perforation).
  • Identification of knowledge gaps in key peri-operative interventions.

Main Results:

  • Emergency laparotomy patients are heterogeneous, with limited understanding of their specific peri-operative trajectories.
  • Current pathways are insufficient, and 'rescue' interventions show some success but are not optimal.
  • Significant knowledge gaps exist regarding multimodal analgesia, haemodynamic optimization, and nutritional support.

Conclusions:

  • Moving beyond 'rescue' pathways requires research into the pathophysiology of intestinal obstruction and perforation.
  • Developing morbidity- and procedure-specific enhanced recovery protocols is essential for emergency laparotomy.
  • Multidisciplinary collaboration and specialized care are crucial for improving outcomes.