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Global guidelines for emergency general surgery: systematic review and Delphi prioritization process.

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    Summary

    Global emergency general surgery (EGS) guidelines were developed to be relevant for all settings, including low-resource environments. These evidence-based recommendations address essential care for critically unwell patients and routine surgical needs.

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    Area of Science:

    • Global Surgery
    • Health Systems Research
    • Clinical Practice Guidelines

    Background:

    • Existing emergency general surgery (EGS) guidelines often lack relevance for low-resource settings.
    • Evidence from low- and middle-income countries (LMICs) is underrepresented in current EGS guidelines.
    • There is a need for universally applicable EGS guidelines.

    Purpose of the Study:

    • To develop global guidelines for emergency general surgery (EGS).
    • To ensure applicability across diverse hospital and health system resource levels.
    • To create evidence-based recommendations suitable for low-resource environments.

    Main Methods:

    • Systematic review and thematic analysis of 38 existing guidelines.
    • International guideline development panel involvement.
    • Four-round Delphi prioritization process with global expert input (219 respondents from LMICs).

    Main Results:

    • Developed 12 recommendations (8 essential, 1 desirable, 3 for critically unwell patients).
    • Recommendations cover preoperative (transfers, CT pathways), perioperative (safety checklists), and postoperative (early warning scores) care.
    • Specific guidance for critically unwell patients includes prioritization for surgery and senior supervision.

    Conclusions:

    • A pragmatic and representative process yielded evidence-based global EGS guidelines.
    • The guidelines are suitable for resource-limited environments worldwide.
    • These guidelines aim to improve EGS care globally, regardless of resource availability.