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Implementing Enhanced Perioperative Care in Emergency General Surgery: A Prospective Multicenter Observational Study

2023; Springer Science+Business Media; Volume: 47; Issue: 6 Linguagem: Inglês

10.1007/s00268-023-06984-9

1432-2323

Marco Ceresoli, Alan Biloslavo, Pietro Bisagni, Carlo Ciuffa, Laura Fortuna, Antonio La Greca, Dario Tartaglia, Mauro Zago, Ferdinando Ficari, Giuseppe Foti, Marco Braga, Francesca Teodora Armao, Andrea Bottari, M Ballabio, Luigi Beretta, Chiara Bondi, Serena Calcinati, Michele Carlucci, Massimo Chiarugi, Arianna Libera Ciravegna, Federico Coccolini, Valerio Cozza, Camilla Cremonini, Federica Ferraina, Valeria Fico, Michele Fogliata, Paola Germani, Luca Gianotti, Samuele Grandi, Lorenzo Guiotto, Enrico Lena, Marco Longhi, Irene Lorenzi, Alessia Malagnino, Marco Montino, Lucia Paiano, Giovanni Pesenti, Sara Riccadonna, Bruno Romanò, Andrea Russo, Riccardo Somigli, Valentina Tomajer, Vincenzo Tripodi,

Hip and Femur Fractures

ERAS pathway has been proposed as the standard of care in elective abdominal surgery. Guidelines on ERAS in emergency surgery have been recently published; however, few evidences are still available in the literature. The aim of this study was to evaluate the feasibility of an enhanced recovery protocol in a large cohort of patients undergoing emergency surgery and to identify possible factors impacting postoperative protocol compliance.This is a prospective multicenter observational study including patients who underwent major emergency general surgery for either intra-abdominal infection or intestinal obstruction. The primary endpoint of the study is the adherence to ERAS postoperative protocol. Secondary endpoints are 30-day mortality and morbidity rates, and length of hospital stay.A total of 589 patients were enrolled in the study, 256 (43.5%) of them underwent intestinal resection with anastomosis. Major complications occurred in 92 (15.6%) patients and 30-day mortality was 6.3%. Median adherence occurred on postoperative day (POD) 1 for naso-gastric tube removal, on POD 2 for mobilization and urinary catheter removal, and on POD 3 for oral intake and i.v. fluid suspension. Laparoscopy was significantly associated with adherence to postoperative protocol, whereas operative fluid infusion > 12 mL/Kg/h, preoperative hyperglycemia, presence of a drain, duration of surgery and major complications showed a negative association.The present study supports that an enhanced recovery protocol in emergency surgery is feasible and safe. Laparoscopy was associated with an earlier recovery, whereas preoperative hyperglycemia, fluid overload, and abdominal drain were associated with a delayed recovery.