{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:56:28Z","timestamp":1787064988303,"version":"build-2736575974"},"reference-count":53,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2020,1,5]],"date-time":"2020-01-05T00:00:00Z","timestamp":1578182400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Standardised peri\u2010operative care pathways for patients undergoing emergency laparotomy or laparoscopy for non\u2010traumatic pathologies have been shown to be inadequate and associated with high morbidity and mortality. Recent research has highlighted this problem and showed that simple pathways with \u2018rescue\u2019 interventions have been associated with reduced mortality when implemented successfully. These rescue pathways have focused on early diagnosis and surgery, specialist surgeon and anaesthetist involvement, goal\u2010directed therapy and intensive or intermediary postoperative care for high\u2010risk patients. In elective surgery, enhanced recovery has resulted in reduced length of stay and morbidity by the application of procedure\u2010specific, evidence\u2010based interventions inside rigorously implemented patient pathways based on multidisciplinary co\u2010operation. The focus has been on attenuation of peri\u2010operative stress and pain management to facilitate early recovery. Patients undergoing emergency laparotomy are a heterogeneous group consisting mostly of patients with intestinal perforations and\/or obstruction with varying levels of comorbidity and frailty. However, present knowledge of the different pathophysiology and peri\u2010operative trajectory of complications in these patient groups is limited. In order to move beyond rescue pathways and to establish enhanced recovery for emergency laparotomy, it is essential that research on both the peri\u2010operative pathophysiology of the different main patient groups \u2013 intestinal obstruction and perforation \u2013 and the potentially differentiated impact of interventions is carried out. Procedure\u2010 and pathology\u2010specific knowledge is lacking on key elements of peri\u2010operative care, such as: multimodal analgesia; haemodynamic optimisation and fluid management; attenuation of surgical stress; nutritional optimisation; facilitation of mobilisation; and the optimal use and organisation of specialised wards and improved interdisciplinary collaboration. As such, the future challenges in improving peri\u2010operative patient care in emergency laparotomy are moving from simple rescue pathways to establish research that can form a basis for morbidity\u2010 and procedure\u2010specific enhanced recovery protocols as seen in elective surgery.<\/jats:p>","DOI":"10.1111\/anae.14902","type":"journal-article","created":{"date-parts":[[2020,1,5]],"date-time":"2020-01-05T20:04:06Z","timestamp":1578254646000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Challenges in optimising recovery after emergency laparotomy"],"prefix":"10.1111","volume":"75","author":[{"given":"N. 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