The application of enhanced recovery after surgery in emergency abdominal surgery
Enhanced recovery after surgery (ERAS) is a multidisciplinary, evidence-based, standardised approach to minimise the stress response to surgery, promote organ function and subsequently improve patient outcome. A large evidence base is now available demonstrating improved patient outcomes and cost savings within elective surgery. Emergency abdominal surgery is performed for a variety of different pathologies in a complex patient population and is associated with a high mortality rate globally. Only recently is evidence emerging demonstrating how similar principles of ERAS can be applied to this cohort of patients. The aim of this article is to collate and review the literature that contributes to the evidence base of ERAS in emergency abdominal surgery. Evidence from a number of studies, the National Emergency Laparotomy Audit (NELA) and other quality improvement projects were identified and reviewed. The overriding theme from this evidence is that when the principles of ERAS (evidence based, standardised protocols) are applied to patients undergoing emergency abdominal surgery, outcomes can be improved while patient safety is preserved. Given the time-critical nature of emergency abdominal surgery, some of the elements of ERAS programmes will not be applicable. Tailored protocols are therefore required to meet the needs of these unique patients. Future developments should focus on identifying ERAS components that improve patient outcomes and incorporating them into effective time-based pathways.