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Geriatric Emergency Surgery ERAS Protocol

Enhanced recovery after emergency surgery in older adults to reduce frailty-related complications.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Geriatric Emergency Surgery ERAS Protocol?

Geriatric Emergency Surgery ERAS (Enhanced Recovery After Surgery) is an adapted bundle of evidence-based perioperative interventions for adults aged 65 and over undergoing acute abdominal surgery (perforated ulcer, obstruction, ischemia, hernia, biliary, colonic). Core elements include rapid frailty screening with the Clinical Frailty Scale, geriatric medicine consult, comprehensive medication reconciliation, early goal-directed fluid therapy, and shared decision-making about treatment limits.

Intraoperative components are minimally invasive technique when feasible, normothermia, restrictive fluid strategy, opioid-sparing multimodal analgesia (acetaminophen, gabapentinoids cautiously, local infiltration, regional blocks), and minimization of long-acting benzodiazepines. Postoperative care emphasizes early oral nutrition, scheduled non-opioid analgesia, daily delirium screening (CAM/4AT), early ambulation, and proactive constipation and urinary retention management.

Outcomes in older emergency surgery patients on geriatric ERAS show 20 to 40 percent reductions in postoperative delirium, pneumonia, and length of stay, with improved 30-day mortality and discharge to home. Key barriers are urgent timing limiting prehabilitation, polypharmacy, dementia, and lack of geriatric expertise; co-management between surgery, geriatrics, and anesthesiology is essential.

Symptoms

Acute abdominal pain in patient over 65
Postoperative delirium and confusion
Polypharmacy and renal impairment
Frailty Clinical Frailty Scale 4 or higher
Falls and pre-existing functional decline
Sarcopenia and unintentional weight loss
Cognitive impairment and dementia

Risk Factors

Age 75 and over
Polypharmacy with anticholinergics
Pre-existing dementia or delirium
Sarcopenia and frailty
Cardiac and renal comorbidity
Emergency rather than elective surgery
Postoperative opioid exposure

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Acute abdominal emergency in elderly
  • Frail patient needing urgent surgery
  • Postoperative confusion or agitation
  • Polypharmacy with new abdominal pain
  • Recurrent admissions and functional decline

Treatment Methods

01
Rapid Clinical Frailty Scale assessment
02
Goals-of-care conversation with family
03
Opioid-sparing multimodal analgesia
04
Early oral nutrition and ambulation
05
Daily delirium screening with CAM or 4AT
06
Avoidance of urinary catheters and restraints
07
Geriatric co-management and discharge planning

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.