Survival After Emergency General Surgery: What can We Learn from Enhanced Recovery Programmes?

Abstract

Enhanced recovery after surgery (ERAS) has been adopted by many centres and across whole healthcare systems. The results have shown significant reductions in length of stay and postoperative complications. However, there has been very little change in these factors and mortality in emergency surgery. Can we learn from principles of ERAS for emergency abdominal surgery?Over the last 15 years, there has been a quiet revolution in the delivery of elective surgical care. The main drivers of these improvements are a combination of improved surgical techniques (laparoscopic and robotic assisted) and evidence-based perioperative pathways, otherwise termed enhanced recovery after surgery (ERAS) [1]. The results have seen significant reductions in postoperative complications, length of stay (LOS) and an improvement in longterm survival after some cancer operations [2,3].

Enhanced Recovery After Surgery (ERAS) - The Evidence in Geriatric Emergency Surgery: A Systematic Review

“…The lower number of trials and studies focusing on ERAS in ES clearly indicates that this is still a new area to explore (16). The studies we found were less homogeneous in focus, included all age groups and different pathologies.…”

“…Quiney et al (16) identified two studies that had applied a specific care pathway with some similarities to ERAS, for ES patients. Their application had resulted in considerably reduced mortality rates.…”

“…providing separate results for both ERAS and ES and ERAS and Elderly. Three relevant editorials (14)(15)(16) were also found during the search. Although these could not be used within the main body of the review due to not fulfilling all our selection criteria, they were included as part of the discussion as offering expert opinion (level 4 of evidence).…”

Multimodal Rehabilitation in Geriatric Emergency Surgery

“…Additionally, a consultant surgeon with wide experience in emergency surgery should be considered for performance of the intervention (3,11,12,16,27). Table 2 shows the recommended amendments to the World Health Organization Surgical Safety Checklist for elderly patients aged >75 years (27).…”

“…Studies have shown that MR protocols were not only feasible but also led to improvements in outcomes (3)(4)(5)(6)(7).…”