Colorectal Enhanced Recovery After Surgery (ERAS) Protocol

Preoperative
Bowel prep, oral antibiotics (mixed data)
Fasting (per ASA guidelines) to avoid aspiration during induction by reducing gastric volume and acidity +/- carbohydrate drink 2 hrs before procedure
No premedications
Optimizing comorbidities
Patient education (of postop care, concerning symptoms, ostomy site selection, and recovery milestones)
Intraoperative:
Antibiotic prophylaxis
Avoid nasogastric tubes
Fluid optimization (net zero balance)
Minimally invasive technique if possible (improves pulmonary function, decreases inflammatory mediators, improves return to bowel function, shorter hospital stay)
Normothermia
Thromboprophylaxis
Postoperative:
Begin enteral feeds on POD1 or within a few hours (no need to wait for flatus or bowel sounds/movement)
Early mobilization, ideally later in day after procedure
Multimodal analgesia and antiemetics (local infiltration, blocks, nonopioid meds) → quicker return of bowel if less opioids
Removal of foley, ideally by POD1
Supplement with high calorie drinks (reduces negative protein balance) 2x/day