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Enhanced recovery after emergency surgery: Utopia or reality?
Rehabilitación multimodal en cirugía de urgencias: ¿utopía o realidad?
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Bakarne Ugarte-Sierraa,
Corresponding author
bakarne.ugartesierra@gmail.com

Corresponding author.
, Aitor Landaluce-Olavarriab, Isaac Cabrera-Sernac, Xavier Viñas-Trullend, Carlo Brugiottie, José Manuel Ramírez-Rodríguezf, Antonio Arroyog
a Servicio de Cirugía general y del Aparato Digestivo, Grupo de Investigación de Cirugía Computacional, BioCruces Bizkaia Health Research Institute, Hospital Universitario de Galdakao, Galdakao, Vizcaya, Spain
b Servicio de Cirugía general y del Aparato Digestivo, Hospital Alfredo Espinosa, Urduliz, Vizcaya, Spain
c Servicio de Cirugía general y del Aparato Digestivo, Hospital Universitario Regional de Málaga, Málaga, Spain
d Servicio de Cirugía general y del Aparato Digestivo, Hospital General de Igualada, Igualada, Barcelona, Spain
e Servicio de Cirugía general y del Aparato Digestivo, Hospital Comarcal de Inca, Inca, Balearic Islands, Spain
f Servicio de Cirugía general y del Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
g Servicio de Cirugía general y del Aparato Digestivo, Hospital General Universitario de Elche, Elche, Alicante, Spain
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Received 03 November 2019. Accepted 26 April 2020
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Tables (2)
Table 1. Multimodal rehabilitation protocol in acute cholecystitis of the Spanish Multimodal Rehabilitation Group.
Table 2. Summary of current recommendations for different pathologies discussed in the text.
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Abstract

Enhanced recovery after surgery (ERAS) constitutes the application of a series of perioperative measures based on the evidence, in order to achieve a better recovery of the patient and a decrease of the complications and the mortality. These ERAS programs initially proved their advantages in the field of colorectal surgery being progressively adopted by other surgical areas within the general surgery and other surgical specialties. The main excluding factor for the application of such programs has been the urgent clinical presentation, which has caused that despite the large volume of existing literature on ERAS in elective surgery, there are few studies that have investigated the effectiveness of these programs in surgical patients in emergencies. The aim of this article is to show ERAS measures currently available according to the existing evidence for emergency surgery.

Keywords:
Enhanced recovery after surgery
Emergency surgery
Acute appendicitis
Acute cholecystitis
Perforated peptic ulcer
Emergency colectomy
Resumen

La rehabilitación multimodal quirúrgica (ERAS) constituye la aplicación de una serie de medidas perioperatorias basadas en la evidencia, con el fin de lograr una mejor recuperación del paciente y una disminución de las complicaciones y la mortalidad. Estos programas de rehabilitación multimodal inicialmente demostraron sus ventajas en el ámbito de la cirugía colorrectal siendo adoptados progresivamente por otras áreas quirúrgicas dentro de la cirugía general y por otras especialidades quirúrgicas. El factor excluyente principal para la aplicación de este tipo de programas ha sido la presentación clínica urgente, lo que ha provocado que a pesar del gran volumen de literatura existente sobre ERAS en cirugía electiva, existan pocos estudios que hayan investigado la efectividad de estos programas en pacientes quirúrgicos en urgencias. El objetivo de este artículo es mostrar las medidas de recuperación intensificada de que disponemos en la actualidad según la evidencia existente para cirugía urgente.

Palabras clave:
Rehabilitación multimodal
Cirugía urgente
Apendicitis aguda
Colecistitis aguda
Úlcera péptica perforada
Colectomía urgente

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