Table 2.
Elements Currently Implemented (N=103)
| Preoperative | |
| Preoperative counseling regarding ERP | 25 (24%) |
| Carbohydrate load | 14 (14%) |
| Avoid prolonged fasting | 71 (69%) |
| Avoid additional bowel preparation | 52 (50%) |
| Provide preoperative antibiotic prophylaxis | 76 (74%) |
| Administer non-opiate preoperative analgesic medications | 64 (62%) |
| Optimize underlying medical conditions | 81 (78%) |
| None of the above | 8 (7%) |
| Median (IQR) [range] preop elements implemented (out of 7) | 4 (IQR 3-5) [range 0-7] |
| Mean (SD) preop elements implemented (out of 7) | 3.7 (2.0) |
| Intraoperative | |
| Use a standardized anesthesia protocol with use of regional anesthesia when possible | 67 (65%) |
| Avoid excess drains | 67 (65%) |
| Maintain intraoperative euvolemia and normothermia | 73 (70%) |
| Minimize intraoperative opioid use | 69 (67%) |
| Minimally invasive approach when able | 74 (72%) |
| Prophylaxis against thromboembolism | 51 (50%) |
| Avoid routine nasogastric tube use | 66 (64%) |
| None of the above | 5 (5%) |
| Median (IQR) [range] intraop elements implemented (out of 7) | 5 (IQR 3-6) [range 0-7] |
| Mean (SD) preop elements implemented (out of 7) | 4.0 (1.0) |
| Postoperative | |
| Encourage post-operative gum chewing | 19 (18%) |
| Implement early feeding (clears ad lib POD 0, regular diet POD 1) | 71 (69%) |
| Have pharmacological medications available for nausea/vomiting prophylaxis as opposed to NGT (Patients may have NGT placed post op if refractory nausea/vomiting) | 71 (69%) |
| Implement early mobilization (out of bed POD 1) | 90 (87%) |
| Use adjunctive pain medication (scheduled acetaminophen or NSAID for first 24 hours) | 86 (84%) |
| Early discontinuation of IV fluids by POD 2 if patient is tolerating oral intake | 62 (60%) |
| Early drain (not foley or other bladder catheters) removal (by POD 4) | 56 (54%) |
| Minimize opioids | 87 (84%) |
| Use insulin to control severe hyperglycemia | 14 (14%) |
| Provide perioperative nutritional optimization (screening or nutritional status evaluation) | 27 (26%) |
| None of the above | 4 (4%) |
| Median (IQR) [range] postop elements implemented (out of 10) | 6 (IQR 4-7) [range 0-10] |
| Mean (SD) postop elements implemented (out of 10) | 5.7 (2.4) |
| Median (IQR) [range] total elements implemented (out of 24) | 15 (IQR 11-18) [range 0-24] |
| Mean (SD) elements implemented (out of 24) | 14.0 (5.5) |