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Article

The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for Perioperative Care

by
Orestis Ioannidis
1,*,
Jose M. Ramirez
2,3,
Javier Martínez Ubieto
2,4,
Carlo V. Feo
5,
Antonio Arroyo
6,
Petr Kocián
7,
Luis Sánchez-Guillén
6,
Ana Pascual Bellosta
2,4,
Adam Whitley
8,
Alejandro Bona Enguita
9,
Marta Teresa
2 and
Elissavet Anestiadou
1
1
Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece
2
Institute for Health Research Aragón, 50009 Zaragoza, Spain
3
Department of Surgery, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
4
Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009 Zaragoza, Spain
5
Department of Surgery, Azienda Unità Sanitaria Locale Ferrara—University of Ferrara, 44121 Ferrara, Italy
6
Department of Surgery, Universidad Miguel Hernández Elche, Hospital General Universitario Elche, 03203 Elche, Spain
7
Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic
8
Department of Surgery, University Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
9
Grupo Español de Rehabilitación Multimodal, 50009 Zaragoza, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2023, 12(13), 4185; https://doi.org/10.3390/jcm12134185
Submission received: 26 April 2023 / Revised: 5 June 2023 / Accepted: 6 June 2023 / Published: 21 June 2023
(This article belongs to the Special Issue Intestinal Obstruction: Etiology and Pathophysiology, Clinical Presentation and Imaging, Diagnosis and Treatment)
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Versions Notes

Abstract

:
Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate.

1. Introduction

While surgery is indicated to for the treatment or palliation of various diseases, in many cases, surgery leads to adverse effects that affect daily living by impairing quality of life and increase the cost of health system because of longer hospitalization time of the patient The goal of the multimodal surgical rehabilitation or enhanced recovery after surgery is the application of a series of perioperative procedure measures and strategies aimed at patients who are going to undergo a surgical procedure with the objective of reducing secondary stress caused by the surgical intervention and thus achieve enhanced recovery of the patient and decrease complications and mortality [1,2]. These care programs are based on scientific evidence, encompass all aspects of patient care, and require multidisciplinary management, with the participation of diverse specialists. Starting at the diagnosis, their aim is to recognize patients’ individual needs, to optimize their treatment before, during and after surgery [1,2].
In order to implement these programs at hospitals in Europe, 5 partners with health and university profile of 4 different EU countries have created the EUPEMEN project. The objective is to prepare a guideline with the protocols to be implemented by the multidisciplinary specialists involved. The Eupemen project has been carried out by Fundación Instituto de Investigación Sanitaria Aragón-IISA as coordinator and Azienda Unità Sanitaria Locale Ferrara—AUSLFE, Univerzita Karlova—CUNI, Universidad Miguel Hernández de Elche—UMH and “G. Papanikolaou—GPAP” General Hospital of Thessaloniki as partners. The main objective of the EUPEMEN project is to create and disseminate protocols for multimodal surgical rehabilitation based on the experience and previous knowledge of the five partners belonging to the health field and higher education. The technical activities of the project included the preparation of the EUPEMEN Multimodal Rehabilitation manual with the protocols of 6 different modules: Bariatric Surgery, Oesophageal Surgery, Gastric Cancer Surgery, Colon Surgery, Hepatobiliary Surgery, and Urgent abdominal surgery, including appendectomy and small bowel obstruction (SBO).

2. Bowel Obstruction

Bowel obstruction is one of the most common surgical emergencies worldwide and accounts for about 15% of cases requiring admission for abdominal pain and constitute about 20% of acute surgical cases [3,4]. SBO accounts for the majority of cases with a percentage of about 75–80% while the rest 20–25% are caused by large bowel obstruction [5].
SBO has been recognized as a medical emergency from the ancient years as descriptions of the disease date back even in the era of ancient Egypt and ancient Greece [6,7]. It is a quiet common emergency medical issue as about 2–4% of abdominal pain cases seen in the emergency department and a percentage as high as 12–16% of surgical admissions are due to SBO [6,8]. In developed countries the most common cause of SBO are adhesions from previous abdominal surgery accounting for 65–78% of the cases, while less common but still not so rare causes are hernias and neoplasms accounting for 10% and 5% respectively [6,9,10]. While the classical dogma of surgery “never let the sun set on a small bowel obstruction” has been challenged the last years and there has been increased focus on successful nonoperative management including the gastrografin challenge [8,9] surgery remains a great part of SBO management and SBO accounts for 20% of all emergency surgical procedures and more than 300,000 operations are performed annually for SBO in the USA [6,11].
For the less common large bowel obstruction, the main cause is neoplasm which account for about 50–60%, with volvulus found in 10–20% and diverticula in another 10–20% [3,4,5]. Contrary to SBO, most cases of large bowel obstruction will require surgical treatment as the majority of cases won’t resolve by observation in combination with medical treatment [3,4,5].

3. Enhanced Recovery after Surgery (ERAS)

Enhanced Recovery After Surgery (ERAS) is a modern approach to perioperative care of surgical patients that aims to reduce surgical stress and thus improve recovery of patients [1,2]. Enhanced recovery protocols aim to ensure that patients are in the best possible conditions before surgery, receive the most optimal surgery and anaesthesia and postoperative care [1,2]. Implementation of enhanced recovery protocols relies on the close collaboration of all specialists participating in the perioperative process, as well as of the actual patients and their relatives [1,2]. The concept of improving recovery after surgery was introduced in the 1990s by Professor Henrik Kehlet [1]. The original protocols were written for colorectal surgery [12,13]. The protocols have since been shown in several randomized clinical trials and meta-analyses to reduce postoperative complications, length of hospitalization, improve clinical recovery parameters and to reduce hospital costs [14,15,16,17,18,19]. Enhanced recovery protocols have now been developed for a wide range of surgical fields, including foregut surgery, pancreatobiliary surgery, gynecological surgery, and urology [14,15,16,17,18,19]. In 2015, in a further attempt to improve postoperative outcomes, the Intensified Recovery in Abdominal Surgery (Via RICA) protocol was developed and published [20]. Via RICA is a detailed enhanced recovery protocol for abdominal surgery based on interdisciplinary consensus. An update for the Via RICA has since been developed, which includes several other surgical disciplines other than abdominal [21] (https://eupemen.eu/wp-content/uploads/2022/10/Eupemen-Protocol-Bowel-Obstruction.pdf, accessed on 24 April 2023). The articles chosen for review and on which the protocol was based are the same articles there were used to develop the via RICA protocol.

4. The EUPEMEN Bowel Obstruction Protocol (Figure 1)

4.1. Preoperative Phase

In the preoperative phase of the management of a patient with SBO, which is performed by the surgeon and the anaesthesiologist, it is important to complete the following routine preoperative assessment that includes physical examination, abdominal X-ray and full blood laboratory analysis including C-reactive protein (CRP).
Also, clinical scoring systems should be implemented for the assessment of elderly patients. Fragility scores should be used such as the Modified Frailty Index and VIG Express and the Beers criteria should be reviewed for preventing delirium in adults over 65 years old. Despite the fact that there is no perfect score, any score is better than none [22,23,24,25,26].
Normothermia should be ensured preoperatively in all patients but especially in frail patients by using heat blankets [27,28,29,30]
One of the most crucial issues is perioperative glycaemic control. Specifically, for diabetic patients the local hospital protocols for diabetics undergoing surgery should be used while in patients at risk of developing insulin resistance (obese and elderly patients) and in surgeries lasting more than one hour, blood glucose levels higher than 180 mg/dL should be avoided [31,32,33,34,35].
Contrary to the protocols in non-emergency surgery nasogastric tube placement is recommended in all cases, while urinary catheterization should be avoided and be used only if necessary.
Perioperative care bundles to prevent surgical site infections are highly recommended and antibiotic prophylaxis should be given in all cases and the type of antibiotics should be chosen according to the local hospital policy [36,37,38,39].
Despite the emergent character of the procedure informed consent is required and the patient should be fully informed of the planned procedure and its potential complications, as it decreases hospital stay and allows early discharge. Competent patients should give signed informed consent [12,14,40,41].

4.2. Intraoperative Phase

In the preoperative phase of the management of a patient with SBO, which is performed by the surgeon, the anaesthesiologist and the nurse the WHO surgical checklist should be used as it increases patient safety [42,43,44,45].
Regarding the anaesthesiologist approach the intraoperative elements of the EUPEMEN protocol are routine intraoperative monitoring, which should include non-invasive blood pressure measurement, electrocardiogram with 5 leads (V5 and DII recommended), fraction of inspired oxygen (FiO2), pulse oximetry (with % O2 Saturation), capnography (EtCO2) [46,47], central temperature [48,49,50], intraoperative blood glucose and fluid therapy balance, rapid sequence induction for anaesthesia and no face mask ventilation in order to reduce aspiration of gastric contents, perioperative oxygenation with a fraction of inspired oxygen between 0.6 and 0.8. Moreover, goal-directed fluid therapy using non-invasive hemodynamic monitoring systems should be used. If such systems are not available, balanced solutions should be given continuously according to the surgical approach: 3–5 mL/kg/h for laparoscopy and 5–7 mL/kg/h for laparotomy [51,52,53,54]. Also, epidural analgesia should be used in open surgery [55,56] and prophylaxis of postoperative nausea and vomiting should be done by the administration of antiemetic therapy according to the Apfel score [57,58,59].
Regarding the surgical elements of the intraoperative component of the EUPEMEN protocol for SBO minimally invasive approaches should only be used in highly selected cases according to the experience of the surgeon. In most cases open surgery should be preferred and abdominal drains should be avoided as much as possible [14,40,60,61,62,63,64,65]. Furthermore, urinary catheterization should be avoided and be used only if necessary [66,67,68].
In the concept of the multidisciplinary management of those patients it is the responsibility of the whole team to achieve perioperative glycaemic control. For diabetic patients’ local hospital protocols for diabetics undergoing surgery should be used while in patients at risk of developing insulin resistance (obese and elderly patients) and in surgeries lasting more than one hour, blood glucose levels higher than 180 mg/dL must be avoided [69,70,71]. Normothermia should be maintained throughout the procedure by the use of thermal blankets and heated fluids [27,28,30,49,72,73,74,75] and thromboembolic prophylaxis consisting of compression stockings or intermittent compression and low-molecular weight heparin should be given according to the local hospital policy [76,77,78,79,80]. Last, but not least perioperative care bundles to prevent surgical site infections are recommended.

4.3. Immediate Postoperative Phase

In the immediate postoperative phase of the management of a patient with SBO, which is performed by the surgeon, the anaesthesiologist and the nurse active temperature maintenance is mandatory and body temperature should be routinely measured with the goal to prevent hypothermia [27,72,73,74,75]. Oxygen saturation should be routinely measured to prevent hyposaturation and if needed oxygen therapy should be used. In the concept of the multidisciplinary management of those patients it is the responsibility of the whole team to achieve perioperative glycaemic control. For diabetic patients, local hospital protocols for diabetics undergoing surgery should be used while in patients at risk of developing insulin resistance (obese and elderly patients) and in surgeries lasting more than one hour, blood glucose levels higher than 180 mg/dL must be avoided. Thromboembolic prophylaxis consisting of compression stockings or intermittent compression and low-molecular weight heparin should be given according to the local hospital policy.
Regarding analgesia it is mandatory to implement opioid-sparing multimodal analgesia [81,82,83,84] and a restrictive fluid therapy protocol. Early mobilisation is one of the goals of the protocol in the immediate postoperative phase and the patients should sit up by two hours after surgery and should begin ambulation 8 h after surgery with respect to night time hours for sleeping [13,14,85,86,87,88,89].
In terms of feeding the patient should be kept nil per os while the withdrawal of the nasogastric tube should be assessed at 12 h after surgery and the removal of the urinary catheter, if it has been used, should be assessed 12 h after surgery.

4.4. First Postoperative Day

During the 1st postoperative day of the management of a patient with SBO, which is performed by the surgeon and the nurse perioperative glycaemic control is one of the key steps. For diabetic patients, local hospital protocols for diabetics undergoing surgery should be used while in patients at risk of developing insulin resistance (obese and elderly patients) and in surgeries lasting more than one hour, blood glucose levels higher than 180 mg/dL must be avoided [69,70,71]. Early mobilization is mandatory in the concept of the protocol and the patients should be fully ambulated in the 1st postoperative day while respiratory physiotherapy is a key element of the protocol [90,91,92,93,94].
Thromboembolic prophylaxis consisting of compression stockings or intermittent compression and low-molecular weight heparin should be given according to the local hospital policy.
Regarding the patients’ medications, antibiotic therapy should be given only in cases of bacterial translocation or abdominal cavity contamination. Broad spectrum antibiotics should be given according to the local hospital policy. Otherwise, the administration of antibiotic prophylaxis only is sufficient. Moreover, regarding pain management opioid-sparing analgesia must be used [55,56,59,95,96,97,98,99,100,101].
In order to easily mobilize the patient nasogastric tube, urinary catheter and epidural catheter removal should be considered. However, as the patients of the protocol are operated for bowel obstruction, while early nasogastric tube removal may be considered, due to the nature of the disease and high output this may not be feasible early in the postoperative period and the nasogastric tube may need to remain even till the second postoperative day. If the nasogastric tube is removed consider commencing a liquid diet or semisolid diet [70,102,103].

4.5. Second Postoperative Day

During the 2st postoperative day of the management of a patient with SBO, which is performed by the surgeon and the nurse perioperative glycaemic control is one of the key steps. For diabetic patients, local hospital protocols for diabetics undergoing surgery should be used while in patients at risk of developing insulin resistance (obese and elderly patients) and in surgeries lasting more than one hour, blood glucose levels higher than 180 mg/dL must be avoided [69,70,71]. Early mobilization is mandatory in the concept of the protocol and the patients should be fully ambulated in the 1st postoperative day while respiratory physiotherapy is a key element of the protocol [90,91,92,93,94]. Thromboembolic prophylaxis consisting of compression stockings or intermittent compression and low-molecular weight heparin should be given according to the local hospital policy. Moreover, regarding pain management opioid-sparing analgesia must be used per os.
In order to easily mobilize the patient nasogastric tube removal should be considered. However, as the patients of the protocol are operated for bowel obstruction, while early nasogastric tube removal may be considered, due to the nature of the disease and high output this may not be feasible early in the postoperative period and the nasogastric tube may need to remain even till the second postoperative day. If the nasogastric tube is removed, consider commencing a liquid diet or semisolid diet. Lastly, early discharge should be assessed according to discharge criteria for cases without intestinal resection.

4.6. Third Postoperative Day

During the 3rd postoperative day of the management of a patient with SBO, which is performed by the surgeon and the nurse, early feeding and early mobilization are key elements as well as respiratory physiotherapy and thromboprophylaxis. Early discharge should be assessed according to discharge criteria.

4.7. Discharge

Patient discharge from the hospital involves the surgeon, nurse and primary care. Regarding thromboprophylaxis, continued individualized thromboprophylaxis should be administrated according to risks while regarding antibiotic therapy it should be consider continuing antibiotic therapy in an outpatient setting in patient with indications. For the patient to be discharged the laboratory blood test should show at least a 50% decline in CRP prior to discharge. Follow-up is mandatory for all patients and follow-up after discharge at 24 h in an outpatient setting or via telephone should be done. Also, patients should be invited for a further follow-up visit according to local hospital policy and if necessary, home support with primary care physician should be coordinated.
Finally, the general discharge criteria are no complications that cannot be managed in an outpatient setting, return of regular bowel movements, no fever, pain controlled with oral analgesia and, importantly, acceptance by the patient.
Jcm 12 04185 g001a 550Jcm 12 04185 g001b 550
Figure 1. The EUPEMEN Protocol for Bowel Obstruction for the Preoperative, Intraoperative and Postoperative Period.
Figure 1. The EUPEMEN Protocol for Bowel Obstruction for the Preoperative, Intraoperative and Postoperative Period.
Jcm 12 04185 g001aJcm 12 04185 g001b

5. ERAS in Bowel Obstruction

The ERAS protocols have been proved to be effective in reducing postoperative complications, morbidity, length of hospital stay and overall cost in elective surgical procedures. While it seems more difficult to implement these protocols in emergency surgery, there are a few studies that have showed not only the feasibility of the protocols in bowel obstruction, both and mainly of the large intestine but also of the small intestine too, but also its advantages [104]. Specifically, the implementation of the ERAS protocol in patients undergoing emergency surgery for bowel obstruction has led to shorter hospital stay [104,105,106,107], decreased morbidity including pulmonary complications, paralytic ileus, surgical site infections [104,106], an increased recovery of gastrointestinal function including decreased time to passing flatus [104], less postoperative pain and better quality of life [104,106], a decreased inflammatory response including reduced CRP and procalcitonin values and also an increased efficacy of treatment in the ERAS group [106].

6. The EUPEMEN Project

The goal of the EUPEMEN project is to bring together the expertise and experience of national clinical champions who have previously helped to deliver major change programmes in their countries and to use them to spread these protocols in Europe. This main goal has been achieved with the next specifics objectives:
  • Preparation of an educational project (that included a teaching the teachers’ model);
  • Implementation in a significant number of European hospitals of the evidence-based protocols in a homogeneous and standardised way;
  • Collection of data about hospital stay, morbidity and mortality of European Surgical patients that once analysed through machine learning algorithm, will be of relevant interest to better know the surgical risk of an individual patient, hence to prevent perioperative complications.
The direct target groups the project aims are health professionals who are directly in charge of the care of surgical patients: surgeons, anaesthesiologists and nurses, as well as health professionals related to the interdisciplinary treatment of these patients: nutritionists, stoma-therapists, physiotherapists, rehabilitators, gastroenterologists, radiotherapists, oncologists, and pathologists. Moreover, as the effectiveness, as depicted by reduction of hospital stays and optimization of the use of other resources, is one of the advantages of these programs, health centres administrator, clinical managers and quality coordinators will also benefit from the project. Finally, due to the characteristics of enhanced recovery, primary care physicians play a very active role too. The indirect target groups of the project are the patients and their relatives and the patients’ associations, while the project’s stakeholders are local, regional, and national authorities and diseases associations.
The technical activities of the project were:
  • The preparation of the EUPEMEN Multimodal Rehabilitation manual with the protocols of 6 different modules:
    • Bariatric Surgery;
    • Oesophageal Surgery;
    • Gastric Cancer Surgery;
    • Colon Surgery;
    • Hepatobiliary Surgery;
    • Urgent abdominal surgery, including appendectomy and small bowel obstruction (SBO).
  • The development of the EUPEMEN online platform (https://eupemen.eu/, accessed on 24 April 2023): to host the e-learning training course and a collaborative area to improve and to participate in the protocols;
  • The training of the trainers to teach the future teachers the different protocol to be able to teach them in the different hospitals;
  • The dissemination of the results in 5 Multiplier events, one per partner, to promote the protocols;
  • The organization of 4 transnational meetings, one per country;
  • The translation into English of the Recovery Intensification for optimal Care in Adult’s surgery—RICA from the Spanish de Recuperación Intensificada en Cirugía del Adulto (RICA).
The results of the project were the development of the EUPEMEN Protocols Training Programme for health professionals, the training of 200 multidisciplinary professionals in all the direct target groups involved in perioperative procedure from each partner in one local forum with 40 participants. Furthermore, the implementation of the protocols in, at least, 5 hospitals in Europe and the creation of a professional network with capacity to train stakeholders in hospitals, and to audit the trainers to guarantee the correct implementation of the programme. Long-term effect and impact of the project will be to decrease the secondary effects after surgery for patients, consequently, with a faster patient recovery, to reduce morbidity and mortality caused after surgical operations and to reduce the length of stay in the hospital and, consequently, save money for the public health system and to have more free beds for other new requested patients.

7. Discussion

The main objective of the project is the uniform, consistent, consensual and multi-centre implementation of the program of perioperative medicine based on the evidence resulting from the clinical pathway of Recovery Intensification for optimal Care in Adult’s surgery (RICA), published by the Ministry of Health, Social Services and Equality and the Aragon Health Sciences Institute, in the hospital centres at a European level, as the implementation of the program in hospitals will mean an important decrease in perioperative complications (morbidity and mortality) in patients included in the program, as well as a shortening of global hospital stays, an improvement in the efficiency of professionals, the inclusion of patients and caregivers in the making of decisions concerning processes, a better and earlier reincorporation of them in their family and social/work environment and an overall improvement of the care given; all of which is related to an overall decrease in the cost per process and resulting in safer processes. The two Intellectual Outputs that were developed were a training manual for the implementation and correct execution of the protocols and a teaching and learning platform completed through the collaboration and cooperation of the participants. The advantages of the project were that these intellectual outputs are innovative and have a transnational added value, as they will be elaborated taking into account the particularities of the different health systems of the participating countries, which will help to elaborate valid protocols in the different countries of the EU, the researchers involved in the project are professionals with experience in research and innovation, and also the innovation of the proposal to modify clinical practice by making it safer and promoting teamwork through the creation of multidisciplinary clinical units that will create synergies that will demonstrate clinical talent and excellence. The evaluation of the implementation results is proposed as a secondary objective by means of the analysis of established indicators and comparing the previously known clinical results with those from the new program, both in the short and long term.

Author Contributions

Conceptualization, O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; methodology, O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; software A.B.E.; validation O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; formal analysis O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; investigation, O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; resources, O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; data curation, O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; writing—original draft preparation O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E., M.T. and E.A.; writing—review and editing O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E., M.T. and E.A.; visualization, O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; supervision, O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; project administration, O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T.; funding acquisition, O.I., J.M.R., J.M.U., C.V.F., A.A., P.K., L.S.-G., A.P.B., A.W., A.B.E. and M.T. All authors have read and agreed to the published version of the manuscript.

Funding

The EUPENEM project has been funded with support of the Erasmus+ Programme of the European Union (Agreement number 2020-1-ES01-KA203-082681). This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Data is contained within the webpage. The data presented in this study are available in [https://eupemen.eu/, accessed on 24 April 2023].

Acknowledgments

The EUPENEM project has been funded with support of the Erasmus+ Programme of the European Union (Agreement number 2020-1-ES01-KA203-082681). This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Ljungqvist, O.; Scott, M.; Fearon, K.C. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017, 152, 292–298. [Google Scholar] [CrossRef] [PubMed]
  2. Scott, M.J.; Baldini, G.; Fearon, K.C.H.; Feldheiser, A.; Feldman, L.S.; Gan, T.J.; Ljungqvist, O.; Lobo, D.N.; Rockall, T.A.; Schricker, T.; et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: Pathophysiological considerations. Acta Anaesthesiol. Scand. 2015, 59, 1212–1231. [Google Scholar] [CrossRef] [Green Version]
  3. Catena, F.; De Simone, B.; Coccolini, F.; Di Saverio, S.; Sartelli, M.; Ansaloni, L. Bowel obstruction: A narrative review for all physicians. World J. Emerg. Surg. 2019, 14, 20. [Google Scholar] [CrossRef] [Green Version]
  4. Gore, R.M.; Silvers, R.I.; Thakrar, K.H.; Wenzke, D.R.; Mehta, U.K.; Newmark, G.M.; Berlin, J.W. Bowel Obstruction. Radiol. Clin. N. Am. 2015, 53, 1225–1240. [Google Scholar] [CrossRef]
  5. Johnson, W.R.; Hawkins, A.T. Large Bowel Obstruction. Clin. Colon. Rectal Surg. 2021, 34, 233–241. [Google Scholar] [CrossRef]
  6. Long, B.; Robertson, J.; Koyfman, A. Emergency Medicine Evaluation and Management of Small Bowel Obstruction: Evidence-Based Recommendations. J. Emerg. Med. 2019, 56, 166–176. [Google Scholar] [CrossRef]
  7. Detz, D.J.; Podrat, J.L.; Muniz Castro, J.C.; Lee, Y.K.; Zheng, F.; Purnell, S.; Pei, K.Y. Small bowel obstruction. Curr. Probl. Surg. 2021, 58, 100893. [Google Scholar] [CrossRef] [PubMed]
  8. D’Agostino, R.; Ali, N.S.; Leshchinskiy, S.; Cherukuri, A.R.; Tam, J.K. Small bowel obstruction and the gastrografin challenge. Abdom. Radiol. 2018, 43, 2945–2954. [Google Scholar] [CrossRef] [PubMed]
  9. Aka, A.A.; Wright, J.P.; DeBeche-Adams, T. Small Bowel Obstruction. Clin. Colon. Rectal Surg. 2021, 34, 219–226. [Google Scholar] [CrossRef] [PubMed]
  10. Bower, K.L.; Lollar, D.I.; Williams, S.L.; Adkins, F.C.; Luyimbazi, D.T.; Bower, C.E. Small Bowel Obstruction. Surg. Clin. N. Am. 2018, 98, 945–971. [Google Scholar] [CrossRef]
  11. Diamond, M.; Lee, J.; LeBedis, C.A. Small Bowel Obstruction and Ischemia. Radiol. Clin. N. Am. 2019, 57, 689–703. [Google Scholar] [CrossRef] [PubMed]
  12. Gustafsson, U.O.; Scott, M.J.; Schwenk, W.; Demartines, N.; Roulin, D.; Francis, N.; McNaught, C.E.; MacFie, J.; Liberman, A.S.; Soop, M.; et al. Enhanced Recovery After Surgery Society. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin. Nutr. 2012, 31, 783–800. [Google Scholar] [CrossRef]
  13. Nygren, J.; Thacker, J.; Carli, F.; Fearon, K.C.; Norderval, S.; Lobo, D.N.; Ljungqvist, O.; Soop, M.; Ramirez, J. Enhanced Recovery After Surgery Society. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin. Nutr. 2012, 31, 801–816. [Google Scholar] [CrossRef]
  14. Gustafsson, U.O.; Scott, M.J.; Hubner, M.; Nygren, J.; Demartines, N.; Francis, N.; Rockall, T.A.; Young-Fadok, T.M.; Hill, A.G.; Soop, M.; et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J. Surg. 2019, 43, 659–695. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  15. Bisch, S.P.; Jago, C.A.; Kalogera, E.; Ganshorn, H.; Meyer, L.A.; Ramirez, P.T.; Dowdy, S.C.; Nelson, G. Outcomes of enhanced recovery after surgery (ERAS) in gynecologic oncology—A systematic review and meta-analysis. Gynecol. Oncol. 2021, 161, 46–55. [Google Scholar] [CrossRef] [PubMed]
  16. Noba, L.; Rodgers, S.; Chandler, C.; Balfour, A.; Hariharan, D.; Yip, V.S. Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: A Systematic Review and Meta-Analysis. J. Gastrointest. Surg. 2020, 24, 918–932. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  17. Lee, Y.; Yu, J.; Doumouras, A.G.; Li, J.; Hong, D. Enhanced recovery after surgery (ERAS) versus standard recovery for elective gastric cancer surgery: A meta-analysis of randomized controlled trials. Surg. Oncol. 2020, 32, 75–87. [Google Scholar] [CrossRef]
  18. Ye, Z.; Chen, J.; Shen, T.; Yang, H.; Qin, J.; Zheng, F.; Rao, Y. Enhanced recovery after surgery (ERAS) might be a standard care in radical prostatectomy: A systematic review and meta-analysis. Ann. Palliat. Med. 2020, 9, 746–758. [Google Scholar] [CrossRef]
  19. Noba, L.; Rodgers, S.; Doi, L.; Chandler, C.; Hariharan, D.; Yip, V. Costs and clinical benefits of enhanced recovery after surgery (ERAS) in pancreaticoduodenectomy: An updated systematic review and meta-analysis. J. Cancer Res. Clin. Oncol. 2023. [Google Scholar] [CrossRef]
  20. Grupo de Trabajo. Vía Clínica de Recuperación Intensificada en Cirugía Abdominal (RICA). Vía Clínica de Recupe- Ración Intensificada en Cirugía Abdominal (RICA) Ministerio de Sanidad, Servicios Sociales e Igualdad. Instituto Aragonés de Ciencias de la Salud. 2014. Available online: https://portal.guiasalud.es/wp-content/uploads/2019/01/vc_1_viaclinica-rica.pdf (accessed on 24 April 2023).
  21. Ramirez, J.; Ruiz-López, P.; Gurumeta, A.; Arroyo-Sebastian, A.; Bruna-Esteban, M.; Sanchez, A.; Calvo-Vecino, J.; García-Erce, J.; García-Fernández, A.; Toro, M.; et al. CLINICAL PATHWAY Recovery Intensification for Optimal Care in Adult’s Surgery. 2021. Available online: https://www.researchgate.net/publication/354723117_CLINICAL_PATHWAY_Recovery_Intensification_for_optimal_Care_in_Adult%27s_surgery (accessed on 24 April 2023).
  22. Dalton, A.; Zafirova, Z. Preoperative Management of the Geriatric Patient: Frailty and Cognitive Impairment Assessment. Anesthesiol. Clin. 2018, 36, 599–614. [Google Scholar] [CrossRef]
  23. Subramaniam, S.; Aalberg, J.; Soriano, R.P.; Divino, C.M. New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data. J. Am. Coll. Surg. 2018, 226, 173–181. [Google Scholar] [CrossRef] [PubMed]
  24. Wang, J.; Zou, Y.; Zhao, J.; Schneider, D.B.; Yang, Y.; Ma, Y.; Huang, B.; Yuan, D. The Impact of Frailty on Outcomes of Elderly Patients After Major Vascular Surgery: A Systematic Review and Meta-analysis. Eur. J. Vasc. Endovasc. Surg. 2018, 56, 591–602. [Google Scholar] [CrossRef] [Green Version]
  25. Castellví Valls, J.; Borrell Brau, N.; Bernat, M.J.; Iglesias, P.; Reig, L.; Pascual, L.; Vendrell, M.; Santos, P.; Viso, L.; Farreres, N.; et al. Colorectal carcinoma in the frail surgical patient. Implementation of a Work Area focused on the Complex Surgical Patient improves postoperative outcome. Cir. Esp. 2018, 96, 155–161. [Google Scholar] [CrossRef] [PubMed]
  26. Shen, Y.; Hao, Q.; Zhou, J.; Dong, B. The impact of frailty and sarcopenia on postoperative outcomes in older patients undergoing gastrectomy surgery: A systematic review and meta-analysis. BMC Geriatr. 2017, 17, 188. [Google Scholar] [CrossRef] [Green Version]
  27. Torossian, A.; Bräuer, A.; Höcker, J.; Bein, B.; Wulf, H.; Horn, E.P. Preventing inadvertent perioperative hypothermia. Clinical Practice Guideline. Dtsch. Arztebl. Int. 2015, 112, 166–172. [Google Scholar] [PubMed] [Green Version]
  28. Warttig, S.; Alderson, P.; Campbell, G.; Smith, A.F. Interventions for treating inadvertent postoperative hypothermia. Cochrane Database Syst. Rev. 2014, 11, CD009892. [Google Scholar] [CrossRef] [Green Version]
  29. Hooper, V.D.; Chard, R.; Clifford, T.; Fetzer, S.; Fossum, S.; Godden, B.; Martinez, E.A.; Noble, K.A.; O’Brien, D.; Odom-Forren, J.; et al. ASPAN’s evidence- based clinical practice guideline for the promotion of perioperative normothermia: Second edition. J. Perianesth. Nurs. 2010, 25, 346–365. [Google Scholar] [CrossRef]
  30. Akhtar, Z.; Hesler, B.D.; Fiffick, A.N.; Mascha, E.J.; Sessler, D.I.; Kurz, A.; Ayad, S.; Saager, L. A randomized trial of prewarming on patient satisfaction and thermal comfort in outpatient surgery. J. Clin. Anesth. 2016, 33, 376–385. [Google Scholar] [CrossRef]
  31. Protocolo de Trabajo del IQZ 2017. Available online: https://infeccionquirurgicazero.es/es/documentos-y-materiales/protocolos-de-trabajo (accessed on 1 June 2020).
  32. Pontes, J.P.J.; Mendes, F.F.; Vasconcelos, M.M.; Batista, N.R. Evaluation and perioperative management of patients with diabetes mellitus. A challenge for the anesthesiologist. Rev. Bras. Anestesiol. 2018, 68, 75–86. [Google Scholar] [CrossRef]
  33. Akiboye, F.; Rayman, G. Management of Hyperglycemia and Diabetes in Orthopedic Surgery. Curr. Diab. Rep. 2017, 17, 13. [Google Scholar] [CrossRef] [Green Version]
  34. Dhatariya, K.; Levy, N.; Hall, G.M. The impact of glycaemic variability on the surgical patient. Curr. Opin. Anaesthesiol. 2016, 29, 430–437. [Google Scholar] [CrossRef] [PubMed]
  35. Membership of the Working Party; Barker, P.; Creasey, P.E.; Dhatariya, K.; Levy, N.; Lipp, A.; Nathanson, M.H.; Penfold, N.; Watson, B.; Woodcock, T. Peri-operative management of the surgical patient with diabetes 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2015, 70, 1427–1440. [Google Scholar] [PubMed]
  36. Allegranzi, B.; Zayed, B.; Bischoff, P.; Kubilay, N.Z.; de Jonge, S.; de Vries, F.; Gomes, S.M.; Gans, S.; Wallert, E.D.; Wu, X.; et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect. Dis. 2016, 16, e288–e303. [Google Scholar] [CrossRef] [PubMed]
  37. Allegranzi, B.; Bischoff, P.; de Jonge, S.; Kubilay, N.Z.; Zayed, B.; Gomes, S.M.; Abbas, M.; Atema, J.J.; Gans, S.; van Rijen, M.; et al. New WHO recommendations on preoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect. Dis. 2016, 16, e276–e287. [Google Scholar] [CrossRef]
  38. Badia, J.M.; Casey, A.L.; Petrosillo, N.; Hudson, P.M.; Mitchell, S.A.; Crosby, C. Impact of surgical site infection on healthcare costs and patient outcomes: A systematic review in six European countries. J. Hosp. Infect. 2017, 96, 1–15. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  39. Proyecto Infección Quirúrgica Zero del Sistema Nacional de Salud. Sociedad Española de Medicina Preventiva, Salud Pública e Higiene. 2016. Available online: https://infeccionquirurgicazero.es/images/stories/recursos/protocolo/2017/3-1-17-documento-Protocolo-IQZ.pdf (accessed on 24 April 2023).
  40. Nelson, G.; Bakkum-Gamez, J.; Kalogera, E.; Glaser, G.; Altman, A.; Meyer, L.A.; Taylor, J.S.; Iniesta, M.; Lasala, J.; Mena, G.; et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update. Int. J. Gynecol. Cancer 2019, 29, 651–668. [Google Scholar] [CrossRef]
  41. Wongkietkachorn, A.; Wongkietkachorn, N.; Rhunsiri, P. Preoperative needs-based education to reduce anxiety, increase satisfaction, and decrease time spent in day surgery: A randomized controlled trial. World J. Surg. 2018, 42, 666–674. [Google Scholar] [CrossRef]
  42. Programa de Cirugía Segura del Sistema Nacional de Salud. Ministerio de Sanidad, Servi- cios Sociales e Igualdad. 2016. Available online: https://seguridaddelpaciente.sanidad.gob.es/practicasSeguras/seguridadBloqueQuirurgico/docs/Protocolo-Proyecto-Cirugia-Segura.pdf (accessed on 24 April 2023).
  43. De Jager, E.; McKenna, C.; Bartlett, L.; Gunnarsson, R.; Ho, Y.H. postoperative Adverse Events Inconsistently Improved by The World Health Organization Surgical Safety Checklist: A Systematic Literature Review of 25 Studies. World J. Surg. 2016, 40, 1842–1858. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  44. Abbott, T.E.F.; Ahmad, T.; Phull, M.K.; Fowler, A.J.; Hewson, R.; Biccard, B.M.; Chew, M.S.; Gillies, M.; Pearse, R.M.; International Surgical Outcomes Study (ISOS) group. The surgical safety checklist and patient outcomes after surgery: Prospective observational cohort study, systematic review and meta-analysis. Br. J. Anaesth. 2018, 120, 146–155. [Google Scholar] [CrossRef] [Green Version]
  45. Biccard, B.M.; Rodseth, R.; Cronje, L.; Agaba, P.; Chikumba, E.; Du Toit, L.; Farina, Z.; Fischer, S.; Gopalan, P.D.; Govender, K.; et al. A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative. S. Afr. Med. J. 2016, 106, 592–597. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  46. Lam, T.; Nagappa, M.; Wong, J.; Singh, M.; Wong, D.; Chung, F. Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis. Anesth. Analg. 2017, 125, 2019–2029. [Google Scholar] [CrossRef]
  47. Frerk, C.; Mitchell, V.S.; McNarry, A.F.; Mendonca, C.; Bhagrath, R.; Patel, A.; O’Sullivan, E.P.; Woodall, N.M.; Ahmad, I. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br. J. Anaesth. 2015, 115, 827–848. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  48. Urits, I.; Jones, M.R.; Orhurhu, V.; Sikorsky, A.; Seifert, D.; Flores, C.; Kaye, A.D.; Viswanath, O. A Comprehensive Update of Current Anesthesia Perspectives on Therapeutic Hypothermia. Adv. Ther. 2019, 36, 2223–2232. [Google Scholar] [CrossRef] [Green Version]
  49. Calvo Vecino, J.M.; Casans Francés, R.; Ripollés Melchor, J.; Marín Zaldívar, C.; Gómez Ríos, M.A.; Pérez Ferrer, A.; Zaballos Bustingorri, J.M.; Abad Gurumeta, A.; Grupo de trabajo de la GPC de Hipotermia Perioperatoria No Intencionada de la SEDAR. Clinical practice guideline. Unintentional perioperative hypothermia. Rev. Esp. Anestesiol. Reanim. 2018, 65, 564–588. [Google Scholar] [CrossRef]
  50. Madden, L.K.; Hill, M.; May, T.L.; Human, T.; Guanci, M.M.; Jacobi, J.; Moreda, M.V.; Badjatia, N. The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society. Neurocrit. Care 2017, 27, 468–487. [Google Scholar] [CrossRef]
  51. Makaryus, R.; Miller, T.E.; Gan, T.J. Current concepts of fluid management in enhanced recovery pathways. Br. J. Anaesth. 2018, 120, 376–383. [Google Scholar] [CrossRef] [Green Version]
  52. Joosten, A.; Delaporte, A.; Ickx, B.; Touihri, K.; Stany, I.; Barvais, L.; Van Obbergh, L.; Loi, P.; Rinehart, J.; Cannesson, M.; et al. Crystalloid versus colloid for intraoperative goal-directed fluid therapy using a closed-loop system: A randomized, double-blinded, controlled trial in major abdominal surgery. Anesthesiology 2018, 128, 55–66. [Google Scholar] [CrossRef]
  53. Kapoor, P.M.; Magoon, R.; Rawat, R.S.; Mehta, Y.; Taneja, S.; Ravi, R.; Hote, M.P. Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass. Ann. Card. Anaesth. 2017, 20, 83–89. [Google Scholar] [CrossRef]
  54. Bacchin, M.R.; Ceria, C.M.; Giannone, S.; Ghisi, D.; Stagni, G.; Greggi, T.; Bonarelli, S. Goal-direted fluid therapy based on stroke volume variation in patients undergoing major spine surgery in the prone position: A cohort study. Spine 2016, 41, E1131–E1137. [Google Scholar] [CrossRef] [Green Version]
  55. Salicath, J.H.; Yeoh, E.C.Y.; Bennett, M.H. Epidural analgesia versus patient-controlled intravenous analgesia for pain following intra-abdominal surgery in adults. Cochrane Database Syst. Rev. 2018, 8, CD010434. [Google Scholar] [CrossRef]
  56. Guay, J.; Nishimori, M.; Kopp, S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Database Syst. Rev. 2016, 7, CD001893. [Google Scholar] [CrossRef] [PubMed]
  57. Apfel, C.C.; Läärä, E.; Koivuranta, M.; Greim, C.A.; Roewer, N. A simplified risk scorefor predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers. Anesthesiology 1999, 91, 693–700. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  58. Apfel, C.C.; Philip, B.K.; Cakmakkaya, O.S.; Shilling, A.; Shi, Y.Y.; Leslie, J.B.; Allard, M.; Turan, A.; Windle, P.; Odom-Forren, J.; et al. Who is at risk for post discharge nausea and vomiting after ambulatory surgery? Anesthesiology 2012, 117, 475–486. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  59. Apfel, C.C.; Heidrich, F.M.; Jukar-Rao, S.; Jalota, L.; Hornuss, C.; Whelan, R.P.; Zhang, K.; Cakmakkaya, O.S. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br. J. Anaesth. 2012, 109, 742–753. [Google Scholar] [CrossRef] [Green Version]
  60. Nelson, G.; Altman, A.D.; Nick, A.; Meyer, L.A.; Ramirez, P.T.; Achtari, C.; Antrobus, J.; Huang, J.; Scott, M.; Wijk, L.; et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations—Part I. Gynecol Oncol. 2016, 140, 313–322. [Google Scholar] [CrossRef] [Green Version]
  61. Nelson, G.; Altman, A.D.; Nick, A.; Meyer, L.A.; Ramirez, P.T.; Achtari, C.; Antrobus, J.; Huang, J.; Scott, M.; Wijk, L.; et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations—Part II. Gynecol Oncol. 2016, 140, 323–332. [Google Scholar] [CrossRef] [Green Version]
  62. Denost, Q.; Rouanet, P.; Faucheron, J.L.; Panis, Y.; Meunier, B.; Cotte, E.; Meurette, G.; Kirzin, S.; Sabbagh, C.; Loriau, J.; et al. To Drain or Not to Drain Infraperitoneal Anas-tomosis After Rectal Excision for Cancer: The GRECCAR 5 Randomized Trial. Ann. Surg. 2017, 265, 474–480. [Google Scholar] [CrossRef]
  63. Carmichael, J.C.; Keller, D.S.; Baldini, G.; Bordeianou, L.; Weiss, E.; Lee, L.; Boutros, M.; McClane, J.; Feldman, L.S.; Steele, S.R. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis. Colon. Rectum 2017, 60, 761–784. [Google Scholar] [CrossRef]
  64. Zhang, H.Y.; Zhao, C.L.; Xie, J.; Ye, Y.W.; Sun, J.F.; Ding, Z.H.; Xu, H.N.; Ding, L. To drain or not to drain in colorectal anastomosis: A meta-analysis. Int. J. Color. Dis. 2016, 31, 951–960. [Google Scholar] [CrossRef] [Green Version]
  65. Musser, J.E.; Assel, M.; Guglielmetti, G.B.; Pathak, P.; Silberstein, J.L.; Sjoberg, D.D.; Bernstein, M.; Laudone, V.P. Impact of routine use of surgical drains on incidence of complications with robot-assisted radical prostatectomy. J. Endourol. 2014, 28, 1333–1337. [Google Scholar] [CrossRef]
  66. Patel, D.; Felder, S.I.; Luu, M.; Daskivich, T.J.; Zaghiyan, K.N.; Fleshner, P. Early Urinary Catheter Removal Following Pelvic Colorectal Surgery: A Prospective, Randomized, Noninferiority Trial. Dis. Colon. Rectum 2018, 61, 1180–1186. [Google Scholar] [CrossRef] [PubMed]
  67. Alyami, M.; Lundberg, P.; Passot, G.; Glehen, O.; Cotte, E. Laparoscopic Colonic Resection Without Urinary Drainage: Is. It “Feasible”? J. Gastrointest. Surg. 2016, 20, 1388–1392. [Google Scholar] [CrossRef]
  68. Zhang, P.; Hu, W.L.; Cheng, B.; Cheng, L.; Xiong, X.K.; Zeng, Y.J. A systematic review and meta- analysis comparing immediate and delayed catheter removal following uncomplicated hysterectomy. Int. Urogynecol. J. 2015, 26, 665–674. [Google Scholar] [CrossRef]
  69. Kotagal, M.; Symons, R.G.; Hirsch, I.B.; Umpierrez, G.E.; Farrokhi, E.T.; Flum, D.R.; SCOAP-Ceertain Collaborative. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann. Surg. 2015, 261, 97–103. [Google Scholar] [CrossRef] [Green Version]
  70. Weimann, A.; Braga, M.; Carli, F.; Higashiguchi, T.; Hübner, M.; Klek, S.; Laviano, A.; Ljungqvist, O.; Lobo, D.N.; Martindale, R.; et al. ESPEN guideline: Clinical nutrition in surgery. Clin. Nutr. 2017, 36, 623–650. [Google Scholar] [CrossRef] [Green Version]
  71. American Diabetes Association. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019, 42 (Suppl. S1), S173–S181. [Google Scholar] [CrossRef] [Green Version]
  72. Torossian, A. Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia. Best. Pract. Res. Clin. Anaesthesiol. 2008, 22, 659–668. [Google Scholar] [CrossRef]
  73. Warttig, S.; Alderson, P.; Lewis, S.R.; Smith, A.F. Intravenous nutrients for preventing inadvertent perioperative hypothermia in adults. Cochrane Database Syst. Rev. 2016, 11, CD009906. [Google Scholar] [CrossRef]
  74. Madrid, E.; Urrútia, G.; Roqué i Figuls, M.; Pardo-Hernandez, H.; Campos, J.M.; Paniagua, P.; Maestre, L.; Alonso-Coello, P. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database Syst. Rev. 2016, 4, CD009016. [Google Scholar] [CrossRef]
  75. Campbell, G.; Alderson, P.; Smith, A.F.; Warttig, S. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Database Syst. Rev. 2015, 4, CD009891. [Google Scholar] [CrossRef]
  76. Felder, S.; Rasmussen, M.S.; King, R.; Sklow, B.; Kwaan, M.; Madoff, R.; Jensen, C. Prolonged thrombo-prophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst. Rev. 2019, 3, CD004318. [Google Scholar] [CrossRef] [PubMed]
  77. Vivas, D.; Roldán, I.; Ferrandis, R.; Marín, F.; Roldán, V.; Tello-Montoliu, A.; Ruiz-Nodar, J.M.; Gómez-Doblas, J.J.; Martín, A.; Llau, J.V.; et al. Perioperative Periprocedural Management of Antithrombotic Therapy: Consensus Document of, S.E.C.; SEDAR; SEACV; SECTCV; AEC; SECPRE; SEPD; SEGO; SEHH; SETH; SEMERGEN; SEMFYC; SEMG; SEMICYUC; SEMI; SEMES; SEPAR; SENEC; SEO; SEPA; SERVEI; SECOT; AEU. Rev. Esp. Cardiol. 2018, 71, 553–564. [Google Scholar] [CrossRef] [PubMed]
  78. Falck-Ytter, Y.; Francis, C.W.; Johanson, N.A.; Curley, C.; Dahl, O.E.; Schulman, S.; Ortel, T.L.; Pauker, S.G.; Colwell, C.W., Jr. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012, 141 (Suppl. S2), e278S–e325S. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  79. Anderson, D.R.; Morgano, G.P.; Bennett, C.; Dentali, F.; Francis, C.W.; Garcia, D.A.; Kahn, S.R.; Rahman, M.; Rajasekhar, A.; Rogers, F.B.; et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: Prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019, 3, 3898–3944. [Google Scholar] [CrossRef]
  80. Afshari, A.; Fenger-Eriksen, C.; Monreal, M.; Verhamme, P.; ESA VTE Guidelines Task Force. European guidelines on perioperative venous thromboembolism prophylaxis: Mechanical prophylaxis. Eur. J. Anaesthesiol. 2018, 35, 112–115. [Google Scholar] [CrossRef] [PubMed]
  81. Mulier, J.P.; Dillemans, B. Anaesthetic Factors Affecting Outcome After Bariatric Surgery, a Retrospective Levelled Regression Analysis. Obes. Surg. 2019, 29, 1841–1850. [Google Scholar] [CrossRef] [Green Version]
  82. Frauenknecht, J.; Kirkham, K.R.; Jacot-Guillarmod, A.; Albrecht, E. Analgesic impact of intra- operative opioids vs. opioid-free anaesthesia: A systematic review and meta-analysis. Anaesthesia 2019, 74, 651–662. [Google Scholar] [CrossRef]
  83. Mulier, J.P.; Wouters, R.; Dillemans, B.; Deckock, M.L. A Randomized Controlled, Double-Blind Trial Evaluating the Effect of Opioid-Free Versus Opioid General Anaesthesia on Postoperative Pain and Discomfort Measured by the QoR-40. J. Clin. Anesth. Pain Med. 2018, 2, 2–6. [Google Scholar]
  84. Mulier, J.P.; Dillemans, B. Deep Neuromuscular Blockade versus Remifentanil or Sevoflurane to Augment Measurable Laparoscopic Workspaceduring Bariatric Surgery Analysed by a Randomissed Controlled Trial. J. Clin. Anesth. Pain Med. 2018, 7, 2–4. [Google Scholar]
  85. Castelino, T.; Fiore, J.F., Jr.; Niculiseanu, P.; Landry, T.; Augustin, B.; Feldman, L.S. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review. Surgery 2016, 159, 991–1003. [Google Scholar] [CrossRef]
  86. de Almeida, E.P.M.; de Almeida, J.P.; Landoni, G.; Galas, F.R.B.G.; Fukushima, J.T.; Fominskiy, E.; de Brito, C.M.M.; Cavichio, L.B.L.; de Almeida, L.A.A.; Ribeiro, U., Jr.; et al. Early mobilization programme improves functional capacity after major abdominal cancer surgery: A randomized controlled trial [with consumer summary]. Br. J. Anaesth. 2017, 119, 900–907. [Google Scholar] [CrossRef] [PubMed]
  87. Schaller, S.J.; Anstey, M.; Blobner, M.; Edrich, T.; Grabitz, S.D.; Gradwohl-Matis, I.; Heim, M.; Houle, T.; Kurth, T.; Latronico, N.; et al. Early, goal-directed mobilization in the surgical intensive care unit: A randomized controlled trial. Lancet 2016, 388, 1377–1388. [Google Scholar] [CrossRef] [PubMed]
  88. Fiore, J.F., Jr.; Castelino, T.; Pecorelli, N.; Niculiseanu, P.; Balvardi, S.; Hershorn, O.; Liberman, S.; Charlebois, P.; Stein, B.; Carli, F.; et al. Ensuring early mobilization within an enhanced recovery program for colorectal surgery: A randomized controlled trial. Ann. Surg. 2017, 266, 223–231. [Google Scholar] [CrossRef] [PubMed]
  89. Wolk, S.; Linke, S.; Bogner, A. Use of Activity Tracking in Major. Visceral Surgery-the Enhanced Perioperative Mobilization Trial: A Randomized Controlled Trial. J. Gastrointest. Surg. 2019, 23, 1218. [Google Scholar] [CrossRef] [PubMed]
  90. Katsura, M.; Kuriyama, A.; Takeshima, T.; Fukuhara, S.; Furukawa, T.A. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst. Rev. 2015, 5, CD010356. [Google Scholar] [CrossRef]
  91. Kalil-Filho, F.A.; Campos, A.C.L.; Tambara, E.M.; Tomé, B.K.A.; Treml, C.J.; Kuretzki, C.H.; Furlan, F.L.S.; Albuquerque, J.P.; Malafaia, O. Physiotherapeutic approaches and the effects on inspiratory muscle force in patients with chronic obstructive pulmonary disease in the pre-operative preparation for abdominal surgical procedures. Arq. Bras. Cir. Dig. 2019, 32, e1439. [Google Scholar] [CrossRef]
  92. Kendall, F.; Oliveira, J.; Peleteiro, B.; Pinho, P.; Bastos, P.T. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: A systematic review and meta-analysis. Disabil. Rehabil. 2018, 40, 864–882. [Google Scholar] [CrossRef]
  93. Alaparthi, G.K.; Augustine, A.J.; Anand, R.; Mahale, A. Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial. Minim. Invasive Surg. 2016, 2016, 1967532. [Google Scholar] [CrossRef] [Green Version]
  94. Karlsson, E.; Farahnak, P.; Franzén, E.; Nygren-Bonnier, M.; Dronkers, J.; van Meeteren, N.; Rydwik, E. Feasibility of preoperative supervised home-based exercise in older adults undergoing colorectal cancer surgery-A randomized controlled design. PLoS ONE 2019, 14, e0219158. [Google Scholar] [CrossRef]
  95. Martinez, V.; Beloeil, H.; Marret, E.; Fletcher, D.; Ravaud, P.; Trinquart, L. Non-opioid analgesics in adults after major surgery: Systematic review with network meta-analysis of randomized trials. Br. J. Anaesth. 2017, 118, 22–31. [Google Scholar] [CrossRef] [Green Version]
  96. Jørgensen, H.; Wetterslev, J.; Møiniche, S.; Dahl, J.B. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst. Rev. 2000, 4, CD001893. [Google Scholar]
  97. McDaid, C.; Maund, E.; Rice, S.; Wright, K.; Jenkins, B.; Woolacott, N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: A systematic review. Health Technol. Assess. 2010, 14, 1–153. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  98. MacFater, W.S.; Rahiri, J.-L.; Lauti, M.; Su’a, B.; Hill, A.G. Intravenous lignocaine in colorectal surgery: A systematic review. ANZ J. Surg. 2017, 87, 879–885. [Google Scholar] [CrossRef]
  99. Weibel, S.; Jokinen, J.; Pace, N.L.; Schnabel, A.; Hollmann, M.W.; Hahnenkamp, K.; Eberhart, L.H.; Poepping, D.M.; Afshari, A.; Kranke, P. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: A systematic review with trial sequential analysis. Br. J. Anaesth. 2016, 116, 770–783. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  100. Weibel, S.; Jelting, Y.; Pace, N.L.; Helf, A.; Eberhart, L.H.; Hahnenkamp, K.; Hollmann, M.W.; Poepping, D.M.; Schnabel, A.; Kranke, P. Continuous intra- venous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst. Rev. 2018, 6, CD009642. [Google Scholar] [PubMed]
  101. Baeriswyl, M.; Zeiter, F.; Piubellini, D.; Kirkham, K.R.; Albrecht, E. The analgesic efficacy of trans- verse abdominis plane block versus epidural analgesia: A systematic review with meta-analysis. Medicine 2018, 97, e11261. [Google Scholar] [CrossRef]
  102. Willcutts, K.F.; Chung, M.C.; Erenberg, C.L.; Finn, K.L.; Schirmer, B.D.; Byham-Gray, L.D. Early oral feeding as compared with traditional timing of oral feeding after upper gastrointestinal surgery. Ann. Surg. 2016, 264, 54–63. [Google Scholar] [CrossRef]
  103. Weimann, A.; Braga, M.; Carli, F.; Higashiguchi, T.; Hübner, M.; Klek, S.; Laviano, A.; Ljungqvist, O.; Lobo, D.N.; Martindale, R.G.; et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021, 40, 4745–4761. [Google Scholar] [CrossRef]
  104. Sharma, J.; Kumar, N.; Huda, F.; Payal, Y.S. Enhanced Recovery After Surgery Protocol in Emergency Laparotomy: A Randomized Control Study. Surg. J. 2021, 7, e92–e99. [Google Scholar] [CrossRef]
  105. Shida, D.; Tagawa, K.; Inada, K.; Nasu, K.; Seyama, Y.; Maeshiro, T.; Miyamoto, S.; Inoue, S.; Umekita, N. Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC Surg. 2017, 17, 18. [Google Scholar] [CrossRef] [Green Version]
  106. Miao, X.; Tao, L.; Huang, L.; Li, J.; Pan, S. Application of Laparoscopy Combined with Enhanced Recovery after Surgery (ERAS) in Acute Intestinal Obstruction and Analysis of Prognostic Factors: A Retrospective Cohort Study. Biomed. Res. Int. 2022, 2022, 5771526. [Google Scholar] [CrossRef] [PubMed]
  107. Saurabh, K.; Sureshkumar, S.; Mohsina, S.; Mahalakshmy, T.; Kundra, P.; Kate, V. Adapted ERAS Pathway Versus Standard Care in Patients Undergoing Emergency Small Bowel Surgery: A Randomized Controlled Trial. J. Gastrointest. Surg. 2020, 24, 2077–2087. [Google Scholar] [CrossRef] [PubMed]
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MDPI and ACS Style

Ioannidis, O.; Ramirez, J.M.; Ubieto, J.M.; Feo, C.V.; Arroyo, A.; Kocián, P.; Sánchez-Guillén, L.; Bellosta, A.P.; Whitley, A.; Enguita, A.B.; et al. The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for Perioperative Care. J. Clin. Med. 2023, 12, 4185. https://doi.org/10.3390/jcm12134185

AMA Style

Ioannidis O, Ramirez JM, Ubieto JM, Feo CV, Arroyo A, Kocián P, Sánchez-Guillén L, Bellosta AP, Whitley A, Enguita AB, et al. The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for Perioperative Care. Journal of Clinical Medicine. 2023; 12(13):4185. https://doi.org/10.3390/jcm12134185

Chicago/Turabian Style

Ioannidis, Orestis, Jose M. Ramirez, Javier Martínez Ubieto, Carlo V. Feo, Antonio Arroyo, Petr Kocián, Luis Sánchez-Guillén, Ana Pascual Bellosta, Adam Whitley, Alejandro Bona Enguita, and et al. 2023. "The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for Perioperative Care" Journal of Clinical Medicine 12, no. 13: 4185. https://doi.org/10.3390/jcm12134185

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