| Pre-operative |
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Information, education and counseling, preferably together with relatives based on an ERAS-specific leaflet (oral and written) Stop smoking Nutritional screening with subsequent nutritional support Patient diary and information about discharge home criteria
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| Day before surgery (−1) |
No standardized procedure for bowel preparation for patients in cohort 1, rectal enema for patients in cohort 2 No fluids or solids after 24:00
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Standardized procedures for bowel preparation (no routine oral bowel preparation, rectal enema for patients in cohort 1) No long-acting sedatives Solid foods until 24:00, encourage light meal 21:00–24:00
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| Peri-operatively |
Active body heating No guidance for nasogastric tubes or drains Standardized combined anesthetic (including thoracal epidural) No guidance for fluid management No specific guidance for vasopressor use
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Active body heating, specified target temperature ≥36°C Avoidance of nasogastric tube after surgery Avoidance of abdominal drains Standardized combined anesthetic (including thoracal epidural) Standardized fluid management: maintenance peri-operatively: Ringer’s acetate 5 mL/kg/hour, infusion pump is used; antibiotic liquid is included in the fluid balance; extra fluid guided by BT, pulse, urine output, peripheral capillary response, PPV; consider use of Lidco, target MAP >60 mm Hg; consider albumin if colloids are needed; blood loss is replaced with erythrocyte concentrates; FFP if bleeding >50% of the blood volume if bleeding is still ongoing bleeding; fluid balance at the end of the operation; ascites is included in the fluid balance, but not replaced; perspiration and 3-room losses are not included Liberal use of vasopressor medications
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| Day 0 |
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300 mL cordial drink 2 hours before surgery Standardized fluid treatment: preferably oral intake, target 30 mL/kg/24 hours Offer a light meal as soon as possible and start with a nutritional drink (Nutridrink Compact Protein 30 mL x 4)
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| Post-operative |
Encourage early oral intake Encourage mobilization No guidance on tapering of epidural Post-operative management included oral opioids (oxycontin/oxynorm and celecoxib)
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Standard mobilization including physiotherapy for patients in cohort 1 on day 1 and 2 Continuation of nutritional drink 30 mL x 4 Standardized anti-emetic treatment 1. choice: droperidol (Dridol) 2. choice: cyclizine (Valoid/Marzine) 3. choice: ondansetron (Zofran) 4. choice: aprepitant (Emend)
Standard postoperative pain treatment (oxycontin/oxynorm and celecoxib), including tapering of epidural Removal of urinary catheter when epidural <5 mL/h Prophylaxis for post-operative ileus Discharge criteria
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