Preadmission |
Information, education, counselling | Strong |
Preoperative optimization (risk assessment, smoking and alcohol cessation) | Strong |
Prehabilitation | Weak |
Preoperative nutritional care (screening and nutrition itself) | Strong |
Management of anemia (targets, interventions) | Strong |
Preoperative |
Prevention of nausea and vomiting | Strong |
Preanesthetic medication (anxiolysis and pain) | Strong |
Antimicrobial prophylaxis and skin preparation | Intravenous antibiotic treatment, chlorhexidine: strong Oral antibiotic treatment, advanced skin decontamination: weak |
Mechanical bowel preparation | Strong |
Preoperative fluid and electrolyte therapy to maintain euvolemia | Strong |
Preoperative fasting and carbohydrate loading up to 2 h before surgery | Strong |
Intraoperative |
Standard Anesthetic Protocol | Strong |
Intraoperative fluid and electrolyte therapy aimed at near-zero fluid balance; goal-directed fluid therapy in patients at high risk | Strong |
Prevention of intraoperative hypothermia | Strong |
Minimally invasive surgical approach (compared to open surgery) | Strong |
Avoidance of routine use of pelvic and peritoneal drains | Strong |
Postoperative |
Avoidance of nasogastric intubation; if placed, removal before reversal of anesthesia | Strong |
Avoidance of opioids; use of NSAIDs; apply multimodal analgesia in combination with spinal/epidural or blocks when indicated | Strong |
Thromboprophylaxis: mechanical prophylaxis until discharge; low-molecular-weight heparin until 28 d postoperatively | Strong |
Fluid and electrolyte administration aimed at near-zero fluid balance, with avoidance of isotonic crystalloids if giving fluid | Strong |
Bladder catheterization for 1–3 d acceptable; catheter should be removed routinely after this period | Strong |
Prevention of postoperative ileus through multimodal strategy | Strong |
Postoperative avoidance of hyperglycemia with insulin therapy and stress-reducing techniques | Stress-reducing: strong Insulin: strong in ICU, weak on ward |
Offering of food on day of surgery; offering of immunonutrition (anti-inflammatory supplements such as L-arginine) to malnourished patients | Strong |
Early mobilization through education and patient encouragement | Strong |