Table 2.
Outline of postoperative management targets in the protocol for the enhanced recovery after surgery (ERAS) programme
| Criteria | |
|---|---|
| Epidural management | Refer to Figure 1 |
| NGT removal | • If 24-h postoperative NGT drainage is <500 ml, NGT can be safely removed and clear oral fluids initiated |
| • EXCLUSION If significant preoperative gastric outlet obstruction was present, seek consultant surgeon opinion prior to removal of NGT | |
| • If persistent vomiting is present thereafter, consider replacement of NGT | |
| DGE = NGT remains in place for >3 days or has been reinserted for persistent vomiting after PoD 3 or inability to tolerate a solid diet by PoD 7 | |
| HDU discharge | Respiratory |
| • Requiring <40% oxygen | |
| • Respiratory rate <20 and >10 breaths/min | |
| • SpO2 >95% (may be lower in patients with COPD) | |
| • Good cough reflex and cooperation with physiotherapy | |
| Cardiovascular | |
| • Not requiring ECG or CVP measurement (although CVP line may be in place) | |
| • Not requiring an arterial line, inotropes or bolus administration of fluid | |
| • Able to mobilize out of bed without need for inotropes | |
| Renal | |
| • Stable renal function, passing ≥25 ml/h urine | |
| • Urea and creatinine not increasing (confirmed on morning of transfer) | |
| Neurological | |
| • Patient alert and obeying commands | |
| Analgesia | |
| • Pain is well controlled on current method of analgesia | |
| Blood tests | |
| • Stable or improving (confirmed on morning of transfer) | |
| General | |
| • Able to mobilize out of bed | |
| Intra-abdominal drain removal | • Monitor daily drain output volumes |
| • PoD 2: drains cut and bagged to facilitate mobilization | |
| • PoD 5: assessment of drain volume nature and amylase content | |
| Drains removed if: | |
| 1 Drain volume is <100 ml | |
| 2 Fluid is clear in colour | |
| 3 Amylase is <300 IU/l | |
| NB If drain removal criteria are not met, further drain management will be at the discretion of the consultant | |
| Hospital discharge | Patients must achieve all of the following: |
| • Adequate pain control on oral analgesia | |
| • Ability to eat and drink with no requirement for i.v. fluids in previous 24 h | |
| • Independent mobility (can mobilize independently to toilet) | |
| • Ability to perform activities of daily living (washing, dressing) without help from nursing staff | |
| • Return of blood tests to normal range | |
| • Willingness to go home | |
NGT, nasogastric tube; HDU, high-dependency unit; DGE, delayed gastric emptying; PoD, postoperative day; SpO2, saturation of peripheral oxygen; COPD chronic obstructive pulmonary disease; ECG, electrocardiogram; CVP, central venous pressure.