Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS^®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care

Michael J Scott^{1

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

6}, Angie Balfour⁷, Nicolai Bang Foss⁸, Zara Cooper⁹, Jugdeep K Dhesi^{10

11}, W Brenton French¹², Michael C Grant¹³, Folke Hammarqvist^{14

15}, Sarah P Hare¹⁶, Joaquim M Havens¹⁷, Daniel N Holena¹⁸, Martin Hübner¹⁹, Carolyn Johnston²⁰, Jeniffer S Kim²¹, Nicholas P Lees²², Olle Ljungqvist²³, Dileep N Lobo^{24

25}, Shahin Mohseni²⁶, Carlos A Ordoñez^{27

28}, Nial Quiney²⁹, Catherine Sharoky³⁰, Richard D Urman³¹, Elizabeth Wick³², Christopher L Wu³³, Tonia Young-Fadok³⁴, Carol J Peden^{35

36}

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Leonard Davis Institute for Health Economics, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA. Michael.Scott@Pennmedicine.Upenn.edu.
² University College London, London, UK. Michael.Scott@Pennmedicine.Upenn.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 Western General Hospital, NHS Lothian, Edinburgh, EH4 2XU, Scotland.
⁸ Hvidovre University Hospital, Copenhagen, Denmark.
⁹ 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.
¹⁰ School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK.
¹¹ Division of Surgery and Interventional Science, University College London, London, UK.
¹² Department of Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street, Richmond, VA, 23298, USA.
¹³ Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
¹⁴ Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
¹⁵ Karolinska University Hospital Huddinge, Hälsovägen 3. B85, 141 86, Stockholm, Sweden.
¹⁶ Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
¹⁷ Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
¹⁸ Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
¹⁹ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
²⁰ Department of Anesthesia, St George's Hospital, Tooting, London, UK.
²¹ Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA, 9110, USA.
²² Department of General and Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, M6 8HD, UK.
²³ Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
²⁴ 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.
²⁵ MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
²⁶ Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, 701 85, Orebro, Sweden.
²⁷ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia.
²⁸ Sección de Cirugía de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cl 5 No. 36-08, 760032, Cali, Colombia.
²⁹ Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX, UK.
³⁰ Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA.
³¹ Department of Anesthesiology, The Ohio State University and Wexner Medical Center, 410 West 10Th Ave, Columbus, OH, 43210, USA.
³² Department of Surgery, University of California San Francisco, 513 Parnassus Ave HSW1601, San Francisco, CA, 94143, USA.
³³ Department of Anesthesiology, Critical Care and Pain Medicine-Hospital for Special Surgery, Department of Anesthesiology-Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
³⁴ 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.
³⁵ Department of Anesthesiology Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA, 90033, USA.
³⁶ Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.

PMID: 37277507
PMCID: PMC10241558
DOI: 10.1007/s00268-023-07020-6

Review

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS^®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care

Michael J Scott et al. World J Surg. 2023 Aug.

. 2023 Aug;47(8):1850-1880.

doi: 10.1007/s00268-023-07020-6. Epub 2023 Jun 5.

Authors

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Leonard Davis Institute for Health Economics, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA. Michael.Scott@Pennmedicine.Upenn.edu.
² University College London, London, UK. Michael.Scott@Pennmedicine.Upenn.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 Western General Hospital, NHS Lothian, Edinburgh, EH4 2XU, Scotland.
⁸ Hvidovre University Hospital, Copenhagen, Denmark.
⁹ 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.
¹⁰ School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK.
¹¹ Division of Surgery and Interventional Science, University College London, London, UK.
¹² Department of Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street, Richmond, VA, 23298, USA.
¹³ Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
¹⁴ Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
¹⁵ Karolinska University Hospital Huddinge, Hälsovägen 3. B85, 141 86, Stockholm, Sweden.
¹⁶ Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
¹⁷ Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
¹⁸ Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
¹⁹ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
²⁰ Department of Anesthesia, St George's Hospital, Tooting, London, UK.
²¹ Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA, 9110, USA.
²² Department of General and Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, M6 8HD, UK.
²³ Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
²⁴ 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.
²⁵ MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
²⁶ Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, 701 85, Orebro, Sweden.
²⁷ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia.
²⁸ Sección de Cirugía de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cl 5 No. 36-08, 760032, Cali, Colombia.
²⁹ Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX, UK.
³⁰ Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA.
³¹ Department of Anesthesiology, The Ohio State University and Wexner Medical Center, 410 West 10Th Ave, Columbus, OH, 43210, USA.
³² Department of Surgery, University of California San Francisco, 513 Parnassus Ave HSW1601, San Francisco, CA, 94143, USA.
³³ Department of Anesthesiology, Critical Care and Pain Medicine-Hospital for Special Surgery, Department of Anesthesiology-Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
³⁴ 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.
³⁵ Department of Anesthesiology Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA, 90033, USA.
³⁶ Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.

PMID: 37277507
PMCID: PMC10241558
DOI: 10.1007/s00268-023-07020-6

Abstract

Background: This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care.

Methods: Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS^® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical 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 elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS^® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL.

Results: Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process.

Conclusions: These guidelines are based on best available evidence for an ERAS^® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

PubMed Disclaimer

Conflict of interest statement

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 and is President of ERAS^®, USA. Dr. Peden has received consultancy fees from the American College of Surgeons Improving Care and Surgical Recovery program and from Medtronic for unrelated work and is Executive Medical Director for Clinical Quality for the Blue Cross Blue Shield Association, USA. Dr. Wu has nothing to disclose. Dr. Hübner has nothing to disclose. Dr. Lees has nothing to disclose. Dr. Lobo has received an unrestricted educational grant from B. Braun and speaker’s honoraria from Abbott, Corza, and Nestlé for unrelated work. He is the Scientific Chair of the ERAS^® Society. Dr. Urman has received research funding or fees from Merck, Covidien/Medtronic, AcelRx, and Pfizer 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. Johnston has nothing to disclose, and 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, Pharmacosmos, Encare AB, and lecturing honoraria from Medtronic and B. Braun outside the related work. Dr. Ljungqvist previously held a now expired patent for a preoperative carbohydrate drink. Angie Balfour—ERAS^® Coach, Encare^®. Co-Director of The Enhanced Recovery after Surgery Society (UK) C.I.C. (not-for-profit organization—Company No. 10932208). No relevant conflict of interest related to this work.

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 funding from the National Institute on Aging and the John A. Hartford Foundation outside of the submitted work. 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. Dr. Sharoky has nothing to disclose. Dr. Anderson has nothing to disclose.

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. doi: 10.1002/bjs.9658. - DOI - PMC - PubMed
1. Lohsiriwat V. Enhanced recovery after surgery vs conventional care in emergency colorectal surgery. World J Gastroenterol. 2014;20:13950–13955. doi: 10.3748/wjg.v20.i38.13950. - DOI - 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. doi: 10.1002/bjs.7429. - DOI - 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. doi: 10.1111/ans.13465. - DOI - 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

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Research Materials
- NCI CPTC Antibody Characterization Program

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

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS^®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care

Affiliations

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS^®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Research Materials