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Implementing Enhanced Perioperative Care in Emergency General Surgery: A Prospective Multicenter Observational Study
Marco Ceresoli1, Alan Biloslavo2, Pietro Bisagni3
1General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Via Pergolesi 33, 20900, Monza, Italy. marco.ceresoli@unimib.it.
World Journal of Surgery
|April 6, 2023
Summary
Enhanced recovery after surgery (ERAS) protocols are feasible and safe in emergency surgery. Laparoscopy promotes faster recovery, while factors like hyperglycemia and drains indicate slower healing.
Area of Science:
- Surgical critical care
- Enhanced recovery after surgery (ERAS) protocols
- Emergency general surgery
Background:
- ERAS protocols are standard for elective surgery, but evidence in emergency settings is limited.
- Recent guidelines address ERAS in emergency surgery, yet further validation is needed.
- This study investigates ERAS protocol feasibility and compliance in emergency abdominal surgery.
Purpose of the Study:
- To assess the feasibility of an enhanced recovery protocol for patients undergoing emergency abdominal surgery.
- To identify factors influencing adherence to postoperative ERAS protocol compliance.
- To evaluate the impact of ERAS on patient outcomes, including mortality, morbidity, and hospital stay.
Main Methods:
- Prospective, multicenter observational study.
- Inclusion of patients undergoing major emergency general surgery for infection or obstruction.
- Primary endpoint: adherence to postoperative ERAS protocol; secondary endpoints: 30-day mortality, morbidity, and length of hospital stay.
Main Results:
- 589 patients enrolled; 43.5% had intestinal resection with anastomosis.
- Major complications occurred in 15.6% of patients, with 6.3% 30-day mortality.
- Laparoscopy correlated with higher protocol adherence; operative fluid overload, hyperglycemia, drains, longer surgery, and complications were associated with lower adherence.
Conclusions:
- Enhanced recovery protocols are feasible and safe for emergency surgery patients.
- Laparoscopic approach facilitates earlier patient recovery.
- Preoperative hyperglycemia, excessive fluid infusion, and abdominal drains are linked to delayed recovery.
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