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. 2025 Jul 12.
doi: 10.1007/s13304-025-02325-8. Online ahead of print.

Adherence to enhanced recovery protocol in emergency general surgery: a prospective observational study

Marco Ceresoli  1   2 , Chiara Fumagalli  3   4 , Alan Biloslavo  5 , Antonio La Greca  6 , Antonella D'addiego  7 , Mauro Zago  8 , Savino Occhionorelli  9 , Pietro Bisagni  10 , Carlo Feo  11 , Dario Tartaglia  12 , Dario Parini  13 , Matteo Runfola  14 , Riccardo Somigli  15 , Diego Visconti  16 , Diego Mariani  17 , Giuseppe Foti  3   18 , Luca Gianotti  3   4   19 , Andrea Mingoli  20 , Enrico Lena  21 , Valeria Fico  6 , Michele Carlucci  7 , Giovanni Pesenti  8 , Domenico Lacavalla  9 , Nicolò Fabbri  11 , Massimo Chiarugi  12 , Michele Ballabio  10 , Giorgia Boschetto  22   23 , Gianandrea Baldazzi  17 , Elisabetta Pusceddu  24 , Elisa Boetti  15 , Mauro Santarelli  16 , Diletta Cassini  25 , Marco Braga  3   4 ; study collaborative group
Collaborators, Affiliations

Adherence to enhanced recovery protocol in emergency general surgery: a prospective observational study

Marco Ceresoli et al. Updates Surg. .

Abstract

Enhanced recovery pathways (ERPs) are evidence-based, multimodal strategies designed to promote early recovery and to optimize surgical outcomes. While extensively implemented in elective surgery, their adaptation to emergency general surgery (EGS) raises challenges due to patient instability and limited preoperative time. The study aimed to evaluate the adherence to each ERPs item and the impact on short-term outcomes in patients undergoing emergency general surgery. This is a multicenter observational prospective study carried out in 13 Italian centers. Inclusion criteria targeted adults undergoing surgery for intestinal occlusion or perforation. Patients re-operated after elective surgery were excluded. The primary endpoints were the adherence to intraoperative ERP items and the compliance to the postoperative recovery pathway. Secondary endpoints were postoperative mortality, morbidity, and length of hospital stay. Between March 2023 and March 2024, 760 patients were analyzed. The highest adherence was observed for active warming (97%), PONV prevention (92%), and long-acting opioid avoidance (87%). The lowest adherence was found for invasive arterial pressure monitoring (35%), depth of anesthesia monitoring (34%), locoregional analgesia (31%), and minimally invasive surgery (26%). By postoperative day 3, 66% of patients tolerated solid diets and 58% had discontinued intravenous fluids. Postoperative mortality, morbidity, and major complications occurred in 3%, 33%, and 9% of patients, respectively. Median hospital stay was 7 days. This study underscores the adherence to ERP in EGS, highlighting the potential of ERP to improve perioperative outcomes in a high-risk population. Future research should prioritize strategies to enhance adherence, particularly to underutilized components as goal-directed fluid therapy and minimally invasive surgery and further optimize ERP protocols for emergency settings.

Keywords: ERAS; Emergency surgery; Enhanced recovery protocol; Perioperative care.

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Conflict of interest statement

Declarations. Conflict of interest: All authors have no conflict of interest to declare. Ethical Standards, Research involving human participants and/or animals, and Informed consent: The study was conducted in compliance to Ethical Stanndards; the protocol was approved by the Ethical review board and all patients signed an informed consent to participate in the study.

References

    1. Gustafsson UO, Scott MJ, Hubner M et al (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World J Surg 43:659–695. https://doi.org/10.1007/s00268-018-4844-y - DOI - PubMed
    1. Braga M, Beretta L, Pecorelli N et al (2018) Enhanced recovery pathway in elderly patients undergoing colorectal surgery: is there an effect of increasing ages? Results from the perioperative Italian Society Registry. Updates Surg 70:7–13. https://doi.org/10.1007/s13304-017-0474-4 - DOI - PubMed
    1. Burcharth J, Falkenberg A, Oreskov JO et al (2021) Patients’ perceptions of barriers to enhanced recovery after emergency abdominal surgery. Langenbecks Arch Surg 406:405–412. https://doi.org/10.1007/s00423-020-02032-5 - DOI - PubMed
    1. Burcharth J, Abdulhady L, Danker J et al (2021) Implementation of a multidisciplinary perioperative protocol in major emergency abdominal surgery. Eur J Trauma Emerg Surg 47:467–477. https://doi.org/10.1007/s00068-019-01238-7 - DOI - PubMed
    1. Gonenc M, Dural AC, Celik F et al (2014) Enhanced postoperative recovery pathways in emergency surgery: a randomised controlled clinical trial. Am J Surg 207:807–814. https://doi.org/10.1016/j.amjsurg.2013.07.025 - DOI - PubMed

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