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article · Current Problems in Surgery

Transforming surgical outcomes in conflict zones: A closed-loop audit of ERAS protocols for emergency laparotomy

2026Open accessUniversity of Gezira

Abstract

Enhanced Recovery After Surgery (ERAS) protocols are pivotal in optimizing perioperative care, yet their implementation in emergency laparotomies, especially in resource-limited, conflict-affected settings, remains underexplored. This prospective clinical audit was conducted at a Sudanese tertiary care hospital between February and May 2024. Forty adult trauma patients undergoing emergency laparotomy were assessed: 20 during the pre-intervention phase and 20 post-intervention following targeted staff training. Initial ERAS compliance was 42.69%, rising to 88.03% post-intervention. Educational interventions improved practices like preoperative patient education (mean increase: 77.5%), abdominal irrigation, and instrument changes before closure (67.5%). Glucose control within 7.7–10 mmol/L achieved a 73% improvement. This study pioneers ERAS protocol application in conflict zones, demonstrating significant adherence improvements through targeted interventions. Tailored strategies, ongoing training, and audit-driven approaches can revolutionize surgical outcomes in under-resourced settings.

Research topics

  • Enhanced Recovery After Surgery
  • Cardiac, Anesthesia and Surgical Outcomes
  • Trauma and Emergency Care Studies

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DOI: 10.1016/j.cpsurg.2026.101983

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