Table 3 Position paper statements
From: Enhanced perioperative care in emergency general surgery: the WSES position paper
Topic | Statement | Agreement | Level of evidence | |
|---|---|---|---|---|
Preoperative | Education and counseling | Patient counselling and education should be encouraged and implemented with the aim to explain perioperative risks and post-operative pathway (LoE D) | 100% | ⨁◯◯◯ |
Fluid balance and volemic status | Volemic status should be evaluated and corrected with a goal-directed fluid therapy as soon as possible in the pre-operative phase (LoE B) | 100% | ⨁⨁⨁◯ | |
Metabolic balance | Glycemic control should be implemented in all emergency surgery patients in order to prevent both hypo- and hyperglycemia (LoE C) | 100% | ⨁⨁◯◯ | |
Intraoperative | Postoperative nausea and vomiting (PONV) prevention | PONV prevention with a multimodal approach in emergency setting should be implemented (LoE D) | 100% | ⨁◯◯◯ |
Benzodiazepines | Benzodiazepines should be avoided in emergency anesthetic protocol, in particular in older patients, in order to reduce delirium risk in post-operative period (LoE C) | 100% | ⨁⨁◯◯ | |
Opioids | Opioid use should be limited to short-acting drugs in the perioperative period (LoE D) | 97.6% | ⨁◯◯◯ | |
Anesthesia depth monitoring | Anesthesia depth monitoring should be implemented in the emergency setting, in order to minimize anesthesia side effects such intra-operative hypotension, increased need for fluids and post-operative delirium (LoE C) | 100% | ⨁⨁◯◯ | |
Neuromuscular blockade monitoring | Neuromuscular blockade monitoring should be implemented in order to reduce post-operative morbidity (LoE C) | 100% | ⨁⨁◯◯ | |
Multimodal pain control | Multimodal analgesia, with a combination of systemic and loco-regional approach, should be encouraged in emergency setting in order to improve pain control and reduce need for analgesics and opioids (LoE C) | 100% | ⨁⨁◯◯ | |
Active warming | Active warming and body temperature monitoring should be encouraged in the emergency setting in order to reduce postoperative morbidity (LoE C) | 100% | ⨁⨁◯◯ | |
Fluid Management | Fluids should be managed within a goal-directed fluid therapy strategy with the goal to target the amount of given fluids on patient needs (LoE C) | 100% | ⨁⨁◯◯ | |
Minimally invasive surgery | Minimally invasive surgery approach in emergency surgery should be encouraged whenever possible and needed skills are available (LoE C) | 100% | ⨁⨁◯◯ | |
Drains | Abdominal drains should be placed for limited indications, including in the presence of gross bacterial contamination and inadequate source control (LoE D) | 88.3% | ⨁◯◯◯ | |
Postoperative | Analgesia | Multimodal analgesia, using different classes of analgesic and avoiding long-acting opioids, should be recommended in post-operative phase (LoE C) | 100% | ⨁⨁◯◯ |
Early nasogastric tube removal | Nasogastric tube should be removed as soon as possible, even at the end of surgery (LoE D) | 97.6% | ⨁◯◯◯ | |
Early mobilization | Early mobilization should be encouraged and stimulated as soon as possible in order to reduce post-operative morbidity (LoE C) | 100% | ⨁⨁◯◯ | |
Nutrition and early oral feeding | Early oral feeding should be encouraged and promoted as soon as tolerated by patients (LoE C) | 100% | ⨁⨁◯◯ | |
Urinary catheter removal | Urinary catheter should be removed as soon as possible, when urinary output no longer needs to be monitored (LoE C) | 100% | ⨁⨁◯◯ | |
Postoperative fluids | Postoperative intravenous. fluids should be minimized and maintained until oral fluid intake is adequate (LoE C) | 100% | ⨁⨁◯◯ | |
Antibiotic therapy | Antibiotic therapy should not be continued in case of non complicated intra-abdominal infections, while a short course antibiotic therapy is indicated in case of complicated infection (LoE A) | 100% | ⨁⨁⨁⨁ |