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

Background 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. Methods 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. Results 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. Conclusion 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.