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Table 1 ERAS society guideline elements for colonic resections

From: Improving enhanced recovery after surgery (ERAS): ERAS APPtimize study protocol, a randomized controlled trial investigating the effect of a patient-centred mobile application on patient participation in colorectal surgery

Element

Responsible

professional

Involvement patient

Preadmission

 1 Cessation of smoking and excessive intake of alcohol

Surgeon, patient

Active

 2 Preoperative nutritional screening and, as needed, assessment and nutritional support

Surgeon

Active/Passive

 3 Medical optimization of chronic disease

Anaesthetist

Passive

Preoperative

 1 Structured preoperative information and engagement of the patient and relatives or caretakers

Nurse

Passive

 2 Preoperative carbohydrate treatment

Nurse

Active/Passive

 3 Preoperative prophylaxis against thrombosis

Surgeon

Active/Passive

 4 Preoperative prophylaxis against infection

Anaesthetist

Passive

 5 Prophylaxis against nausea and vomiting

Anaesthetist

Passive

Intraoperative

 1 Minimal invasive surgical techniques

Surgery

Passive

 2 Standardized anesthesia, avoiding long-acting opioids

Anaesthetist

Passive

 3 Maintaining fluid balance to avoid over- or under hydration, administer vasopressors to support blood pressure control

Anaesthetist

Passive

 4 Epidural anesthesia for open surgery

Anaesthetist

Passive

 5 Restrictive use of surgical site drains

Surgeon

Passive

 6 Removal of nasogastric tubes before reversal of anesthesia

Anaesthetist

Passive

 7 Control of body temperature using warm air flow blankets and warmed intravenous infusions

Anaesthetist

Passive

Postoperative

 1 Early mobilization (day of surgery)

Patient

Active

 2 Early intake of oral fluids and solids (offered the day of surgery)

Patient

Active

 3 Early removal of urinary catheters and intravenous fluids (morning after surgery)

Nurse

Active/Passive

 4 Use of chewing gums and laxatives and peripheral opioid-blocking agents (when using opioids)

Patient

Active

 5 Intake of protein and energy-rich nutritional supplements

Patient

Active

 6 Multimodal approach to opioid-sparing pain control

Anaesthetist

Passive

 7 Multimodal approach to control of nausea and vomiting

Anaesthetist

Passive

 8 Prepare for early discharge

Nurse, patient

Active/Passive

 9 Audit of outcomes and process in a multi-professional, multidisciplinary team on a regular basis

Whole team

Passive