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Guidelines on ERAS in emergency surgery have been recently published; however, few evidences are still available in the literature. The aim of this study was to evaluate the feasibility of an enhanced recovery protocol in a large cohort of patients undergoing emergency surgery and to identify possible factors impacting postoperative protocol compliance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a prospective multicenter observational study including patients who underwent major emergency general surgery for either intra\u2010abdominal infection or intestinal obstruction. The primary endpoint of the study is the adherence to ERAS postoperative protocol. Secondary endpoints are 30\u2010day mortality and morbidity rates, and length of hospital stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 589 patients were enrolled in the study, 256 (43.5%) of them underwent intestinal resection with anastomosis. Major complications occurred in 92 (15.6%) patients and 30\u2010day mortality was 6.3%. Median adherence occurred on postoperative day (POD) 1 for naso\u2010gastric tube removal, on POD 2 for mobilization and urinary catheter removal, and on POD 3 for oral intake and i.v. fluid suspension. Laparoscopy was significantly associated with adherence to postoperative protocol, whereas operative fluid infusion\u2009&gt;\u200912\u00a0mL\/Kg\/h, preoperative hyperglycemia, presence of a drain, duration of surgery and major complications showed a negative association.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The present study supports that an enhanced recovery protocol in emergency surgery is feasible and safe. Laparoscopy was associated with an earlier recovery, whereas preoperative hyperglycemia, fluid overload, and abdominal drain were associated with a delayed recovery.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-023-06984-9","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T16:02:37Z","timestamp":1680796957000},"page":"1339-1347","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Implementing Enhanced Perioperative Care in Emergency General Surgery: A Prospective Multicenter Observational Study"],"prefix":"10.1002","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7935-3842","authenticated-orcid":false,"given":"Marco","family":"Ceresoli","sequence":"first","affiliation":[{"name":"General and Emergency Surgery Department, School of Medicine and Surgery Milano\u2010Bicocca University Via Pergolesi 33 20900 Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Biloslavo","sequence":"additional","affiliation":[{"name":"General Surgery Department Cattinara Hospital, ASUGI Strada Di Fiume, 447 34149 Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Bisagni","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery ASST Lodi Lodi Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Ciuffa","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery IRCCS Ospedale San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Fortuna","sequence":"additional","affiliation":[{"name":"General Surgery Ospedale S. 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