Enhanced perioperative care in emergency general surgery: the WSES position paper

Marco Ceresoli^{1

2}, Marco Braga^{3

4}, Nicola Zanini⁵, Fikri M Abu-Zidan⁶, Dario Parini⁷, Thomas Langer^{3

8}, Massimo Sartelli⁹, Dimitrios Damaskos¹⁰, Walter L Biffl¹¹, Francesco Amico¹², Luca Ansaloni¹³, Zsolt J Balogh¹⁴, Luigi Bonavina¹⁵, Ian Civil¹⁶, Enrico Cicuttin¹³, Mircea Chirica¹⁷, Yunfeng Cui¹⁸, Belinda De Simone¹⁹, Isidoro Di Carlo²⁰, Andreas Fette²¹, Giuseppe Foti^{3

22}, Michele Fogliata^{3

4}, Gustavo P Fraga²³, Paola Fugazzola¹³, Joseph M Galante²⁴, Solomon Gurmu Beka²⁵, Andreas Hecker²⁶, Johannes Jeekel²⁷, Andrew W Kirkpatrick²⁸, Kaoru Koike²⁹, Ari Leppäniemi^{30

31}, Ingo Marzi³², Ernest E Moore³³, Edoardo Picetti³⁴, Emmanouil Pikoulis³⁵, Michele Pisano³⁶, Mauro Podda³⁷, Boris E Sakakushev³⁸, Vishal G Shelat^{39

40}, Edward Tan⁴¹, Giovanni D Tebala⁴², George Velmahos⁴³, Dieter G Weber⁴⁴, Vanni Agnoletti⁴⁵, Yoram Kluger⁴⁶, Gianluca Baiocchi⁴⁷, Fausto Catena⁵, Federico Coccolini⁴⁸

Affiliations

¹ School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy. marco.ceresoli@unimib.it.
² General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy. marco.ceresoli@unimib.it.
³ School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
⁴ General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy.
⁵ General Surgery Department, Bufalini Hospital, Cesena, Italy.
⁶ The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
⁷ General Surgery Department - Santa Maria Della Misericordia Hospital, Rovigo, Italy.
⁸ Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁹ General Surgery, Macerata Hospital, Macerata, Italy.
¹⁰ Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹¹ Scripps Memorial Hospital La Jolla, La Jolla, CA, USA.
¹² John Hunter Hospital Trauma Service and School of Medicine and Public Health, The University of Newcastle, Newcastle, AU, Australia.
¹³ General Surgery, Fondazione IRCCS San Matteo, Pavia, Italy.
¹⁴ Department of Traumatology, John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, Newcastle, NSW, Australia.
¹⁵ Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
¹⁶ University of Auckland, Auckland, New Zealand.
¹⁷ Department of Digestive Surgery, CHU Grenoble Alpes, Grenoble, France.
¹⁸ Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
¹⁹ Unit of Emergency and Trauma Surgery, Villeneuve St Georges Academic Hospital, Villeneuve St Georges, France.
²⁰ Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.
²¹ PS_SS Weissach im Tal, Weissach im Tal, Germany.
²² Department of Critical Care and Anesthesia, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
²³ Division of Trauma Surgery, School of Medical Sciences (FCM), University of Campinas (Unicamp), Campinas, Brazil.
²⁴ University of California, Davis, Sacramento, CA, USA.
²⁵ University of Otago, Dunebin, New Zealand.
²⁶ Department of General and Thoracic Surgery, University Hospital of Giessen, Gießen, Germany.
²⁷ Erasmus MC University, Rotterdam, The Netherlands.
²⁸ General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada.
²⁹ Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
³⁰ Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
³¹ Andrei Litvin, CEO AI Medica Hospital Center, Kaliningrad, Russia.
³² Department of Trauma, Hand, and Reconstructive Surgery, Goethe University, Frankfurt University Hospital, Frankfurt am Main, Germany.
³³ Director of Surgery Research, Ernest E. Moore Shock Trauma Center, Distinguished Professor of Surgery, University of Colorado, Denver, CO, USA.
³⁴ Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
³⁵ Third Department of Surgery, Attikon University Hospital, Athene, Greece.
³⁶ General Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy.
³⁷ Department of Surgical Science, University of Cagliari, Cagliari, Italy.
³⁸ RIMU Plovdiv/UMHAT St George Plovdiv, Plovdiv, Bulgaria.
³⁹ Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
⁴⁰ Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
⁴¹ Former Chair Department of Emergency Medicine, HEMS Physician, Radboud University Medical Center, Nijmegen, The Netherlands.
⁴² Digestive and Emergency Surgery Department, Azienda Ospedaliera S.Maria, Terni, Italy.
⁴³ Harvard Medical School - Massachusetts General Hospital, Boston, USA.
⁴⁴ Department of General Surgery, Royal Perth Hospital, Head of Service and Director of Trauma, Royal Perth Hospital, The University of Western Australia, Perth, Australia.
⁴⁵ Anesthesia and Critical Care Department, Bufalini Hospital, Cesena, Italy.
⁴⁶ Department of General Surgery, The Rambam Academic Hospital, Haifa, Israel.
⁴⁷ General Surgery, University of Brescia, ASST Cremona, Cremona, Italy.
⁴⁸ Emergency Surgery, University of Pisa, Pisa, Italy.

PMID: 37803362
PMCID: PMC10559594
DOI: 10.1186/s13017-023-00519-2

Review

Enhanced perioperative care in emergency general surgery: the WSES position paper

Marco Ceresoli et al. World J Emerg Surg. 2023.

. 2023 Oct 6;18(1):47.

doi: 10.1186/s13017-023-00519-2.

Authors

Affiliations

¹ School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy. marco.ceresoli@unimib.it.
² General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy. marco.ceresoli@unimib.it.
³ School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
⁴ General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy.
⁵ General Surgery Department, Bufalini Hospital, Cesena, Italy.
⁶ The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
⁷ General Surgery Department - Santa Maria Della Misericordia Hospital, Rovigo, Italy.
⁸ Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁹ General Surgery, Macerata Hospital, Macerata, Italy.
¹⁰ Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹¹ Scripps Memorial Hospital La Jolla, La Jolla, CA, USA.
¹² John Hunter Hospital Trauma Service and School of Medicine and Public Health, The University of Newcastle, Newcastle, AU, Australia.
¹³ General Surgery, Fondazione IRCCS San Matteo, Pavia, Italy.
¹⁴ Department of Traumatology, John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, Newcastle, NSW, Australia.
¹⁵ Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
¹⁶ University of Auckland, Auckland, New Zealand.
¹⁷ Department of Digestive Surgery, CHU Grenoble Alpes, Grenoble, France.
¹⁸ Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
¹⁹ Unit of Emergency and Trauma Surgery, Villeneuve St Georges Academic Hospital, Villeneuve St Georges, France.
²⁰ Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.
²¹ PS_SS Weissach im Tal, Weissach im Tal, Germany.
²² Department of Critical Care and Anesthesia, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
²³ Division of Trauma Surgery, School of Medical Sciences (FCM), University of Campinas (Unicamp), Campinas, Brazil.
²⁴ University of California, Davis, Sacramento, CA, USA.
²⁵ University of Otago, Dunebin, New Zealand.
²⁶ Department of General and Thoracic Surgery, University Hospital of Giessen, Gießen, Germany.
²⁷ Erasmus MC University, Rotterdam, The Netherlands.
²⁸ General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada.
²⁹ Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
³⁰ Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
³¹ Andrei Litvin, CEO AI Medica Hospital Center, Kaliningrad, Russia.
³² Department of Trauma, Hand, and Reconstructive Surgery, Goethe University, Frankfurt University Hospital, Frankfurt am Main, Germany.
³³ Director of Surgery Research, Ernest E. Moore Shock Trauma Center, Distinguished Professor of Surgery, University of Colorado, Denver, CO, USA.
³⁴ Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
³⁵ Third Department of Surgery, Attikon University Hospital, Athene, Greece.
³⁶ General Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy.
³⁷ Department of Surgical Science, University of Cagliari, Cagliari, Italy.
³⁸ RIMU Plovdiv/UMHAT St George Plovdiv, Plovdiv, Bulgaria.
³⁹ Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
⁴⁰ Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
⁴¹ Former Chair Department of Emergency Medicine, HEMS Physician, Radboud University Medical Center, Nijmegen, The Netherlands.
⁴² Digestive and Emergency Surgery Department, Azienda Ospedaliera S.Maria, Terni, Italy.
⁴³ Harvard Medical School - Massachusetts General Hospital, Boston, USA.
⁴⁴ Department of General Surgery, Royal Perth Hospital, Head of Service and Director of Trauma, Royal Perth Hospital, The University of Western Australia, Perth, Australia.
⁴⁵ Anesthesia and Critical Care Department, Bufalini Hospital, Cesena, Italy.
⁴⁶ Department of General Surgery, The Rambam Academic Hospital, Haifa, Israel.
⁴⁷ General Surgery, University of Brescia, ASST Cremona, Cremona, Italy.
⁴⁸ Emergency Surgery, University of Pisa, Pisa, Italy.

PMID: 37803362
PMCID: PMC10559594
DOI: 10.1186/s13017-023-00519-2

Abstract

Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients' outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.

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Conflict of interest statement

All the authors have no conflict of interest to declare.

Figures

**Fig. 1**
Enhanced perioperative care items and interventions

**Fig. 2**
Perioperative diagram of patient’s homeostasis in elective and emergency general surgery

See this image and copyright information in PMC

References

1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg [Internet] 2017;152:292–298. - PubMed
1. Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg [Internet] 2014;38:1531–1541. - PubMed
1. Lee Y, Yu J, Doumouras AG, Li J, Hong D. Enhanced recovery after surgery (ERAS) versus standard recovery for elective gastric cancer surgery: a meta-analysis of randomized controlled trials. Surg Oncol. 2020;32:75–87. - PubMed
1. Ni X, Jia D, Chen Y, Wang L, Suo J. Is the enhanced recovery after surgery (ERAS) program effective and safe in laparoscopic colorectal cancer surgery? A meta-analysis of randomized controlled trials. J Gastrointest Surg [Internet] 2019;23:1502–1512. - PubMed
1. Ni X, Jia D, Guo Y, Sun X, Suo J. The efficacy and safety of enhanced recovery after surgery (ERAS) program in laparoscopic digestive system surgery: a meta-analysis of randomized controlled trials. Int J Surg. 2019;69:108–115. - PubMed

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Enhanced perioperative care in emergency general surgery: the WSES position paper

Affiliations

Enhanced perioperative care in emergency general surgery: the WSES position paper

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources