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      Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—Preoperative: Diagnosis, Rapid Assessment and Optimization

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          Abstract

          Background

          Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach.

          Methods

          Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled 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 non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1—Preoperative Care and Part 2—Intraoperative and Postoperative management. This paper provides guidelines for Part 1.

          Results

          Twelve components of preoperative care were considered. Consensus was reached after three rounds.

          Conclusions

          These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.

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          Most cited references144

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          The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

          Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.
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            Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

            To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".
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              American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

              (2019)
              The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3-year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674-694, 2019.
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                Author and article information

                Contributors
                carol.peden@med.usc.edu
                geetaaggarwal@nhs.net
                rjaitken@me.com
                iain.anderson@srft.nhs.uk
                nbfoss@gmail.com
                zcooper@bwh.harvard.edu
                Jugdeep.Dhesi@gstt.nhs.uk
                william.french@vcuhealth.org
                mgrant17@jhmi.edu
                folke.hammarqvist@ki.se
                Sarah.hare1@nhs.net
                jhavens@bwh.harvard.edu
                Daniel.Holena@pennmedicine.upenn.edu
                martin.hubner@chuv.ch
                Jeniffer.Kim@med.usc.edu
                nick.lees@srft.nhs.uk
                olle.ljungqvist@oru.se
                Dileep.Lobo@nottingham.ac.uk
                ordonezcarlosa@gmail.com
                nialquiney@nhs.net
                rurman@bwh.harvard.edu
                Elizabeth.Wick@ucsf.edu
                eduwuch@hss.edu
                youngfadok.tonia@mayo.edu
                Michael.Scott@Pennmedicine.Upenn.edu
                Journal
                World J Surg
                World J Surg
                World Journal of Surgery
                Springer International Publishing (Cham )
                0364-2313
                1432-2323
                6 March 2021
                6 March 2021
                2021
                : 45
                : 5
                : 1272-1290
                Affiliations
                [1 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Department of Anesthesiology and Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, , University of Southern California, ; 2020 Zonal Avenue IRD 322, Los Angeles, CA 90033 USA
                [2 ]GRID grid.25879.31, ISNI 0000 0004 1936 8972, Department of Anesthesiology, , University of Pennsylvania, ; 3400 Spruce St, Philadelphia, PA 19104 USA
                [3 ]GRID grid.416224.7, ISNI 0000 0004 0417 0648, 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 ]GRID grid.412346.6, ISNI 0000 0001 0237 2025, Salford Royal NHS Foundation Trust, ; Stott La, Salford, M6 8HD UK
                [6 ]GRID grid.5379.8, ISNI 0000000121662407, University of Manchester, ; Manchester, UK
                [7 ]GRID grid.411905.8, ISNI 0000 0004 0646 8202, Hvidovre University Hospital, ; Copenhagen, Denmark
                [8 ]GRID grid.62560.37, ISNI 0000 0004 0378 8294, 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
                [9 ]GRID grid.83440.3b, ISNI 0000000121901201, Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, Division of Surgery & Interventional Science, , University College London, ; London, UK
                [10 ]GRID grid.224260.0, ISNI 0000 0004 0458 8737, Department of Surgery, , Virginia Commonwealth University Health System, ; 1200 E. Broad Street, Richmond, VA 23298 USA
                [11 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Anesthesiology and Critical Care Medicine, Department of Surgery, , The Johns Hopkins University School of Medicine, ; 1800 Orleans Street, Baltimore, MD 21287 USA
                [12 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Department of Emergency and Trauma Surgery, Karolinska University Hospital, , CLINTEC, Karolinska Institutet, ; Stockholm, Sweden
                [13 ]GRID grid.24381.3c, ISNI 0000 0000 9241 5705, Karolinska University Hospital, ; Huddinge Hälsovägen 3. B85, S 141 86, Stockholm, Sweden
                [14 ]GRID grid.439210.d, ISNI 0000 0004 0398 683X, Department of Anaesthesia, Perioperative Medicine and Critical Care, , Medway Maritime Hospital, ; Windmill Road, Gillingham, Kent, ME7 5NY UK
                [15 ]GRID grid.62560.37, ISNI 0000 0004 0378 8294, Division of Trauma, Burns and Surgical Critical Care, , Brigham and Women’s Hospital, ; 75 Francis Street, Boston, MA 02115 USA
                [16 ]GRID grid.25879.31, ISNI 0000 0004 1936 8972, Department of Surgery and Critical Care Medicine, , University of Pennsylvania, ; Philadelphia, PA 19104 USA
                [17 ]GRID grid.9851.5, ISNI 0000 0001 2165 4204, Department of Visceral Surgery, Lausanne University Hospital CHUV, , University of Lausanne (UNIL), ; Rue du Bugnon 46, 1011 Lausanne, Switzerland
                [18 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, , University of Southern California, ; 2020 Zonal Avenue IRD 322, Los Angeles, CA 90033 USA
                [19 ]GRID grid.412346.6, ISNI 0000 0001 0237 2025, Department of General & Colorectal Surgery, , Salford Royal NHS Foundation Trust, ; Scott La, Salford, M6 8HD UK
                [20 ]GRID grid.15895.30, ISNI 0000 0001 0738 8966, Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, , Örebro University, ; Örebro, Sweden
                [21 ]GRID grid.415598.4, ISNI 0000 0004 0641 4263, 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
                [22 ]MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
                [23 ]GRID grid.15895.30, ISNI 0000 0001 0738 8966, Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital & School of Medical Sciences, , Örebro University, ; 701 85 Örebro, Sweden
                [24 ]GRID grid.477264.4, Division of Trauma and Acute Care Surgery, Department of Surgery, , Fundación Valle del Lili, ; Cra 98 No. 18 – 49, 760032 Cali, Colombia
                [25 ]GRID grid.411286.8, Sección de Cirugía de Trauma Y Emergencias, , Universidad del Valle – Hospital Universitario del Valle, ; Cl 5 No. 36-08, 760032 Cali, Colombia
                [26 ]GRID grid.416224.7, ISNI 0000 0004 0417 0648, Department of Anesthesia and Intensive Care Medicine, , Royal Surrey County Hospital, ; Egerton Road, Guildford, Surrey, GU5 7XX UK
                [27 ]GRID grid.62560.37, ISNI 0000 0004 0378 8294, Department of Anesthesiology, Perioperative and Pain Medicine, , Brigham and Women’s Hospital / Harvard Medical School, ; 75 Francis Street, Boston, MA 02115 USA
                [28 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Department of Surgery, , University of California San Francisco, ; 513 Parnassus Ave HSW1601, San Francisco, CA 94143 USA
                [29 ]GRID grid.239915.5, ISNI 0000 0001 2285 8823, Department of Anesthesiology, , Critical Care and Pain Medicine-Hospital for Special Surgery, ; 535 East 70th Street, New York, NY 10021 USA
                [30 ]GRID grid.5386.8, ISNI 000000041936877X, Department of Anesthesiology, , Weill Cornell Medicine, ; 535 East 70th Street, New York, NY 10021 USA
                [31 ]GRID grid.417468.8, ISNI 0000 0000 8875 6339, 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
                [32 ]GRID grid.25879.31, ISNI 0000 0004 1936 8972, Department of Anesthesiology and Critical Care Medicine, , University of Pennsylvania, ; 3400 Spruce St, Philadelphia, PA 19104 USA
                Author information
                http://orcid.org/0000-0001-5795-4217
                http://orcid.org/0000-0002-5423-8730
                http://orcid.org/0000-0001-5653-6478
                http://orcid.org/0000-0003-2688-5794
                http://orcid.org/0000-0003-1272-990X
                http://orcid.org/0000-0003-1187-5796
                http://orcid.org/0000-0001-7097-487X
                http://orcid.org/0000-0003-4495-7405
                http://orcid.org/0000-0002-0516-5977
                http://orcid.org/0000-0003-3643-3505
                Article
                5994
                10.1007/s00268-021-05994-9
                8026421
                33677649
                75861c15-30b3-4636-8edd-da2f3109e271
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 30 January 2021
                Categories
                Original Scientific Report
                Custom metadata
                © Société Internationale de Chirurgie 2021

                Surgery
                Surgery

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