Emergency Surgery

Emergency surgery presents unique and complex challenges that set it apart from elective procedures. Patients requiring emergency laparotomy — those with non-elective, potentially life-threatening intra-abdominal conditions — are among the highest-risk surgical patients, and outcomes including mortality remain significantly worse than in planned surgery.

While ERAS has largely been applied to elective surgery, there is now compelling evidence that high-risk surgical patients undergoing emergency laparotomy can also benefit significantly from a structured ERAS approach. ERAS protocols have been shown to reduce length of stay, complications, and costs across a wide range of surgical procedures, and a similar structured approach appears to improve outcomes — including mortality — for patients undergoing emergency general surgery.

What makes emergency laparotomy distinct is the additional requirement to manage acute physiological derangement before, during, and after surgery — a challenge that demands a unique pathway beyond standard elective ERAS protocols. Common underlying conditions include intestinal obstruction, perforation, and exploratory laparotomy, each requiring rapid assessment, simultaneous resuscitation, and timely surgical intervention.

The ERAS® Society has developed the first consensus guidelines specifically for this patient group, spanning preoperative diagnosis and optimization, intra- and postoperative care, and the organisational aspects essential to delivering a safe, effective pathway. Because of the diverse underlying conditions and varying presentations of emergency surgical patients, not all pathway components will always be applicable — but the principles of structured, evidence-based perioperative care are relevant to all teams, hospitals, and systems seeking to improve outcomes for this vulnerable population.