EFFECTIVENESS OF ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOLS IN ACCELERATING POSTOPERATIVE RECOVERY FOLLOWING EMERGENCY SURGERY FOR ACUTE ABDOMINAL CONDITIONS

Abstract

Emergency surgery for acute abdominal conditions, including intestinal obstruction, perforated gastrointestinal lesions, acute appendicitis, complicated cholecystitis, and diffuse peritonitis, is associated with substantial physiological stress and an increased risk of postoperative complications. Conventional postoperative management may involve prolonged fasting, delayed mobilization, excessive opioid administration, and unnecessary maintenance of invasive devices. Enhanced Recovery After Surgery (ERAS) protocols represent a multidisciplinary approach designed to minimize surgical stress, preserve physiological function, and facilitate safe recovery. Although ERAS principles are well established in elective surgery, their application in emergency abdominal surgery requires adaptation to the severity of the underlying disease and the patient's clinical condition. A narrative literature review was conducted using published clinical guidelines, consensus recommendations, systematic reviews, and meta-analyses addressing perioperative care in emergency abdominal surgery. Particular attention was given to postoperative length of hospital stay, gastrointestinal recovery, postoperative complications, mobilization, pain management, nutritional support, and the safety of early discharge. Evidence from studies comparing ERAS-based management with conventional perioperative care was critically assessed. No original patient cohort was recruited, and no new clinical data were generated. Published evidence suggests that ERAS-based care may shorten postoperative hospitalization, accelerate the return of bowel function, reduce postoperative nausea and vomiting, and facilitate earlier mobilization. A 2024 systematic review and meta-analysis involving 20 studies included 1,615 patients managed using ERAS protocols and 1,933 patients receiving conventional care. The analysis reported a reduction in hospital stay of approximately 3.35 days in upper gastrointestinal surgery and 2.80 days in lower gastrointestinal surgery. A separate 2024 meta-analysis of six randomized controlled trials involving 509 patients also reported shorter hospitalization and improvements in several postoperative outcomes. Nevertheless, the certainty of evidence varies, and the effects of individual ERAS components remain difficult to separate.