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

Ceresoli, Marco; Braga, Marco; Zanini, Nicola; Abu-Zidan, Fikri M.; Parini, Dario; Langer, Thomas; Sartelli, Massimo; Damaskos, Dimitrios; Biffl, Walter L.; Amico, Francesco; Ansaloni, Luca; Balogh, Zsolt J.; Bonavina, Luigi; Civil, Ian; Cicuttin, Enrico; Chirica, Mircea; Cui, Yunfeng; De Simone, Belinda; Di Carlo, Isidoro; Fette, Andreas; Foti, Giuseppe; Fogliata, Michele; Fraga, Gustavo P.; Fugazzola, Paola; Galante, Joseph M.; Beka, Solomon Gurmu; Hecker, Andreas; Jeekel, Johannes; Kirkpatrick, Andrew W.; Koike, Kaoru; Leppäniemi, Ari; Marzi, Ingo; Moore, Ernest E.; Picetti, Edoardo; Pikoulis, Emmanouil; Pisano, Michele; Podda, Mauro; Sakakushev, Boris E.; Shelat, Vishal G.; Tan, Edward; Tebala, Giovanni D.; Velmahos, George; Weber, Dieter G.; Agnoletti, Vanni; Kluger, Yoram; Baiocchi, Gianluca; Catena, Fausto; Coccolini, Federico

doi:10.1186/s13017-023-00519-2

Cited by 7 publications

(6 citation statements)

References 126 publications

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“…Postoperative opioid-related adverse effects, including nausea/vomiting, respiratory depression, sedation, and paralytic ileus, have been extensively documented [8]. In this study, the indiscriminate use of opioids among patients in the control group was due to non-compliance with the World Health Organization (WHO) analgesic ladder prior to the implementation of new pain management protocols by our institution in 2021.…”

Section: Discussionmentioning

confidence: 90%

“…In both the ERP group and the control group, abdominal drains were placed only in cases of liver and pancreatic injuries known for posing a higher risk of leak and stula formation [25,27]. Although more indications for drainage following penetrating trauma laparotomy may exist, in comparison with elective or other emergency surgeries, the early removal of drains can be safe while contributing to better recovery outcomes [8]. As observed in our study, the early removal of abdominal drains and chest tubes was signi cant in patients following the our proposed protocol (mean 4 vs. 8 days, p = 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Some of their bene ts include lower complication rates, faster recovery, shorter hospital stays, earlier resumption of regular activities, improved patient satisfaction, and cost savings. As a result of increasing expertise, ERPs approaches have also been successfully used in different settings and for different surgical specialties, more recently in surgical emergencies [1,7,8]. However, data on the implementation of ERPs in trauma surgery are limited, and their suitability for injured patients undergoing laparotomy remains unclear.…”

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confidence: 99%

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Applying enhanced recovery principles to emergency laparotomy in penetrating abdominal trauma: a case-matched study

Fonseca,

Rizental,

Cunha

et al. 2024

Preprint

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Purpose: The implementation of enhanced recovery after surgery programs (ERPs) has significantly improved outcomes within various surgical specialties. However, the suitability of ERPs in trauma surgery remains unclear. This study aimed to 1) design and implement an ERP for trauma laparotomy patients; 2) assess its safety, feasibility, and efficacy; and 3) compare the outcomes of the proposed ERP with conventional practices. Methods: This case-matched study prospectively enrolled hemodynamically stable patients undergoing emergency laparotomy after penetrating trauma. Patients receiving the proposed ERP were compared with historical controls managed according to conventional practices. Cases were matched for age, sex, injury mechanism, extra-abdominal injuries, and trauma scores. Assessment of intervention effects were modelled using regression analysis for outcome measures, including length of hospital stay (LOS), postoperative complications, and functional recovery parameters. Results: Thirty-six consecutive patients were enrolled in the proposed ERP and matched to their 36 historical counterparts, totaling 72 participants. A statistically significant decrease in LOS, representing a 39% improvement in average LOS was observed. There was no difference in the incidence of postoperative complications. Opioid consumption was considerably lower in the ERP group (p<0.010). Time to resumption of oral liquid and solid intake, as well as to the removal of nasogastric tubes, urinary catheters, and abdominal drains was significantly earlier among ERP patients (p<0.001). Conclusion: The implementation of a standardized ERP for the perioperative care of penetrating abdominal trauma patients yielded a significant reduction in LOS without increasing postoperative complications. These findings demonstrate that ERPs principles can be safely applied to selected trauma patients.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Applying enhanced recovery principles to emergency laparotomy in penetrating abdominal trauma: a case-matched study

Fonseca,

Rizental,

Cunha

et al. 2024

Preprint

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“…The WSES also provided its own indication for the implementation of the ERAS protocol in a recently published position paper [106]. From their perspective, the adherence to enhanced recovery program may improve patient compliance as a chained process, which can result in reduced LHS with no increasing complication and readmission.…”

Section: Eras Principles In Emergency Surgerymentioning

confidence: 99%

Enhanced recovery after surgery (ERAS) in Emergency and Trauma Surgery

Bollino,

Yu,

Luppi

et al. 2024

Contemporary Approach to Trauma and Emergency Surgery

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Enhanced Recovery After Surgery (ERAS) protocols reduce the length of hospital stay (LHS), complications, and costs for many elective surgical procedures. The ERAS protocol concerns a multimodal, multidisciplinary, standardized, evidence-based approach to minimize stress for patients undergoing surgery. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and emergency laparotomy, in particular. Recently, several studies have been published, including new guidelines, analyzing the benefits of ERAS protocols in emergency surgery and trauma patients. The aim of this chapter is to analyze the available data and the benefits of using ERAS protocols in patients undergoing emergency and trauma surgery.

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“…The primary objectives of early mobilization and rehabilitation are to improve recovery and minimize complications that may arise from extended length of hospital stay (LOS). 5 …”

Section: Introductionmentioning

confidence: 99%

Enhanced wound recovery after surgery care in patients with total knee arthroplasty: A meta‐analysis

Wang,

Lin

2024

International Wound Journal

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This study primarily focussed on the impact of Enhanced Recovery After Surgery (ERAS) care on wound healing and pain management in patients undergoing total knee arthroplasty (TKA). TKA is the critical surgical intervention aimed at improving the quality of life in patients with knee osteoarthritis. While this procedure has been effective in enhancing mobility and life quality, postoperative phase, particularly wound healing, remains significant concern. This research aimed to evaluate the effectiveness of ERAS care protocols in promoting wound healing and reducing postoperative wound pain. A comprehensive literature review was conducted to identify studies focusing on wound healing and pain management in TKA patients under ERAS care. The systematic search employed various terms related to TKA, wound healing and ERAS. During the screening process, data relevant to wound healing outcomes were prioritized for inclusion in the meta‐analysis. Using the R package ‘meta’, meta‐analysis was performed on a sample of 664 patients, divided into 349 in the intervention group (ERAS care) and 315 in the control. The results indicated significant enhancement in wound healing and reduction in postoperative wound pain among patients receiving ERAS care (risk ratio [RR] = 1.12, 95% confidence interval [CI]: 0.9152; 1.3929, p < 0.01). Additionally, pain score analysis across the studies revealed that the ERAS group consistently experienced less wound pain postoperatively compared with the control, with average of 0.1 point difference in pain scores indicating significantly less pain. Conclusively, our findings underscored the importance of implementing structured ERAS care protocols in TKA procedures. These protocols not only alleviated postoperative wound pain but also promoted effective wound healing, thereby potentially enhancing overall recovery and surgical outcomes for patients with knee osteoarthritis undergoing TKA.

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

Cited by 7 publications

References 126 publications

Applying enhanced recovery principles to emergency laparotomy in penetrating abdominal trauma: a case-matched study

Applying enhanced recovery principles to emergency laparotomy in penetrating abdominal trauma: a case-matched study

Enhanced recovery after surgery (ERAS) in Emergency and Trauma Surgery

Enhanced wound recovery after surgery care in patients with total knee arthroplasty: A meta‐analysis

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