Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS

Area of Science:

• Surgical critical care
• Enhanced Recovery After Surgery (ERAS) protocols
• Emergency general surgery

Background:

• This paper presents Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL).
• It focuses specifically on the intraoperative and postoperative phases of care.
• The guidelines utilize an Enhanced Recovery After Surgery (ERAS) approach.

Purpose of the Study:

• To establish consensus guidelines for the intraoperative and postoperative management of emergency laparotomy patients.
• To provide evidence-based recommendations for optimizing care in high-risk surgical populations.
• To outline key components of ERAS protocols applicable to emergency laparotomy.

Main Methods:

• International ERAS Society experts reviewed literature from PubMed, Cochrane, Embase, and Medline.
• Studies were graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
• A modified Delphi method was employed to reach consensus on 23 components of care.

Main Results:

• Twenty-three distinct components of intraoperative and postoperative care were identified.
• Consensus was achieved through three rounds of a modified Delphi process.
• Recommendations were formulated based on the best available evidence.

Conclusions:

• The guidelines offer an evidence-based ERAS approach for emergency laparotomy patients.
• They highlight important care components for this high-risk group.
• Further research is needed as evidence is often extrapolated from elective or general emergency surgery.