Learning curve of enhanced recovery after surgery program in open colorectal surgery

Table 1 Enhanced recovery after surgery protocol for open colorectal surgery

Preadmission

1 Cessation of smoking and intake of alcohol; 2 Nutrition assessment and nutrition support as needed; 3 Medical optimization of chronic disease

Preoperative

4 Structured preoperative counseling to patients and their relatives; 5 No mechanical bowel preparation; 6 Administration of appropriate prophylactic antibiotics; 7 Prophylaxis of postoperative nausea and vomiting

Intraoperative

8 Use of epidural anesthesia; 9 Use of atraumatic O-ring wound retractor/protector; 10 Avoid hypothermia; 11 Maintaining fluid balance and vasopressors to support blood pressure control; 12 No intraabdominal or pelvic drain

Postoperative

13 Early intake of oral fluids and semi-solid foods (day of surgery); 14 Early ambulation (postoperative day 1); 15 Multimodal approach to opioid-sparing pain control; 16 Removal of urinary catheter by postoperative day 3; 17 Discontinuous intravenous fluid infusion by postoperative day 3