Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization

Carol J Peden^{1

2}, Geeta Aggarwal³, Robert J Aitken⁴, Iain D Anderson^{5

6}, Nicolai Bang Foss⁷, Zara Cooper⁸, Jugdeep K Dhesi⁹, W Brenton French¹⁰, Michael C Grant¹¹, Folke Hammarqvist^{12

13}, Sarah P Hare¹⁴, Joaquim M Havens¹⁵, Daniel N Holena¹⁶, Martin Hübner¹⁷, Jeniffer S Kim¹⁸, Nicholas P Lees¹⁹, Olle Ljungqvist²⁰, Dileep N Lobo^{21

22}, Shahin Mohseni²³, Carlos A Ordoñez^{24

25}, Nial Quiney²⁶, Richard D Urman²⁷, Elizabeth Wick²⁸, Christopher L Wu^{29

30}, Tonia Young-Fadok³¹, Michael Scott³²

Affiliations

¹ Department of Anesthesiology and Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA, 90033, USA. carol.peden@med.usc.edu.
² Department of Anesthesiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA. carol.peden@med.usc.edu.
³ Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK.
⁴ Sir Charles Gardiner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
⁵ Salford Royal NHS Foundation Trust, Stott La, Salford, M6 8HD, UK.
⁶ University of Manchester, Manchester, UK.
⁷ Hvidovre University Hospital, Copenhagen, Denmark.
⁸ Harvard Medical School, Kessler Director, Center for Surgery and Public Health, Brigham and Women's Hospital and Division of Trauma, Burns, Surgical Critical Care, and Emergency Surgery, Brigham and Women's Hospital, 1620, Tremont Street, Boston, MA, 02120, USA.
⁹ Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, Guy's and St Thomas' NHS Foundation Trust, King's College London, Division of Surgery & Interventional Science, University College London, London, UK.
¹⁰ Department of Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street, Richmond, VA, 23298, USA.
¹¹ Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
¹² Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
¹³ Karolinska University Hospital, Huddinge Hälsovägen 3. B85, S 141 86, Stockholm, Sweden.
¹⁴ Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
¹⁵ Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
¹⁶ Department of Surgery and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
¹⁷ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
¹⁸ Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA, 90033, USA.
¹⁹ Department of General & Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, M6 8HD, UK.
²⁰ Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
²¹ Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
²² MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
²³ Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital & School of Medical Sciences, Örebro University, 701 85, Örebro, Sweden.
²⁴ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia.
²⁵ Sección de Cirugía de Trauma Y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cl 5 No. 36-08, 760032, Cali, Colombia.
²⁶ Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX, UK.
²⁷ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital / Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
²⁸ Department of Surgery, University of California San Francisco, 513 Parnassus Ave HSW1601, San Francisco, CA, 94143, USA.
²⁹ Department of Anesthesiology, Critical Care and Pain Medicine-Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
³⁰ Department of Anesthesiology, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
³¹ Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
³² Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.

PMID: 33677649
PMCID: PMC8026421
DOI: 10.1007/s00268-021-05994-9

Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization

Carol J Peden et al. World J Surg. 2021 May.

. 2021 May;45(5):1272-1290.

doi: 10.1007/s00268-021-05994-9. Epub 2021 Mar 6.

Authors

Affiliations

¹ Department of Anesthesiology and Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA, 90033, USA. carol.peden@med.usc.edu.
² Department of Anesthesiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA. carol.peden@med.usc.edu.
³ Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK.
⁴ Sir Charles Gardiner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
⁵ Salford Royal NHS Foundation Trust, Stott La, Salford, M6 8HD, UK.
⁶ University of Manchester, Manchester, UK.
⁷ Hvidovre University Hospital, Copenhagen, Denmark.
⁸ Harvard Medical School, Kessler Director, Center for Surgery and Public Health, Brigham and Women's Hospital and Division of Trauma, Burns, Surgical Critical Care, and Emergency Surgery, Brigham and Women's Hospital, 1620, Tremont Street, Boston, MA, 02120, USA.
⁹ Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, Guy's and St Thomas' NHS Foundation Trust, King's College London, Division of Surgery & Interventional Science, University College London, London, UK.
¹⁰ Department of Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street, Richmond, VA, 23298, USA.
¹¹ Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
¹² Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
¹³ Karolinska University Hospital, Huddinge Hälsovägen 3. B85, S 141 86, Stockholm, Sweden.
¹⁴ Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
¹⁵ Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
¹⁶ Department of Surgery and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
¹⁷ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
¹⁸ Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA, 90033, USA.
¹⁹ Department of General & Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, M6 8HD, UK.
²⁰ Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
²¹ Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
²² MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
²³ Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital & School of Medical Sciences, Örebro University, 701 85, Örebro, Sweden.
²⁴ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia.
²⁵ Sección de Cirugía de Trauma Y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cl 5 No. 36-08, 760032, Cali, Colombia.
²⁶ Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX, UK.
²⁷ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital / Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
²⁸ Department of Surgery, University of California San Francisco, 513 Parnassus Ave HSW1601, San Francisco, CA, 94143, USA.
²⁹ Department of Anesthesiology, Critical Care and Pain Medicine-Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
³⁰ Department of Anesthesiology, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
³¹ Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
³² Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.

PMID: 33677649
PMCID: PMC8026421
DOI: 10.1007/s00268-021-05994-9

Abstract

Background: Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach.

Methods: Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1-Preoperative Care and Part 2-Intraoperative and Postoperative management. This paper provides guidelines for Part 1.

Results: Twelve components of preoperative care were considered. Consensus was reached after three rounds.

Conclusions: These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.

PubMed Disclaimer

Conflict of interest statement

Dr. Peden has received consultancy fees from the American College of Surgeons Improving Care and Surgical Recovery program and from the Institute for Healthcare Improvement, and from Merck for unrelated work. Dr. Scott has honoraria from and serves on advisory boards of Baxter, Edwards Lifesciences, Deltex, Trevena, and Merck. He also receives travel reimbursement from these companies. Dr. Lobo has received speaker honoraria for unrelated work from Fresenius Kabi in the last 3 years and is the Scientific Chair of the ERAS® Society. Dr. Wu has nothing to disclose. Dr. Hübner has nothing to disclose. Dr. Lees has nothing to disclose. Dr. Urman has received research funding or fees from Merck, Covidien/Medtronic, AcelRx, Pfizer and Takeda outside the submitted work, as well as federal funding from NIH, AHRQ and NSF. Dr. Aitken has nothing to disclose. Dr. Grant has nothing to disclose. Dr. Hammarqvist has nothing to disclose. Dr. Hare has nothing to disclose. Dr. Havens has research grant funding from Johnson and Johnson outside the submitted work. Dr Ljungqvist is the Chairman of the ERAS® Society, founded and owns stock in Encare AB, and has received honoraria for advice, lecturing including travel support from Nutricia, Fresenius-Kabi, Pharamcosmos, Encare AB, and lecturing honoraria from Medtronic and BBraun outside the related work. Dr Ljungqvist previously held a now expired patent for a preoperative carbohydrate drink. Dr. Ordoñez has nothing to disclose. Dr. Kim has nothing to disclose. Dr. French has nothing to disclose. Dr. Aggarwal has nothing to disclose. Dr. Quiney has nothing to disclose. Dr. Holena has nothing to disclose. Dr. Cooper has nothing to disclose. Dr. Wick has funding from the Agency for Healthcare Research and Quality outside the submitted work. Dr. Bang Foss has nothing to disclose. Dr. Young-Fadok has nothing to disclose. Dr. Mohseni has nothing to disclose. Dr. Dhesi has nothing to disclose.

Figures

**Fig. 1**
The hour-1 surviving sepsis campaign bundle of care. From Levy et al. [63]

See this image and copyright information in PMC

Comment in

Invited Commentary: "Guidelines for Perioperative Care for Emergency: Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization".
de Boer HD, Demartines N. de Boer HD, et al. World J Surg. 2021 May;45(5):1291-1292. doi: 10.1007/s00268-021-06083-7. Epub 2021 Mar 25. World J Surg. 2021. PMID: 33768308 No abstract available.

References

1. Huddart S, Peden CJ, Swart M, et al. Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy. Br J Surg. 2015;102:57–66. - PMC - PubMed
1. Lohsiriwat V. Enhanced recovery after surgery vs conventional care in emergency colorectal surgery. World J Gastroenterol. 2014;20:13950–13955. - PMC - PubMed
1. Møller MH, Adamsen S, Thomsen RW, et al. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg. 2011;98:802–810. - PubMed
1. Wisely JC, Barclay KL. Effects of an enhanced recovery after surgery programme on emergency surgical patients. ANZ J Surg. 2016;86:883–888. - PubMed
1. Roulin D, Blanc C, Muradbegovic M, et al. Enhanced recovery pathway for urgent colectomy. World J Surg. 2014;38:2153–2159. doi: 10.1007/s00268-014-2518-y. - DOI - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

MR/P021220/1/MRC_/Medical Research Council/United Kingdom

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization

Affiliations

Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical