Table 2.

Summary of Improving Surgical Care and Recovery Colorectal Protocol Components, Associated Outcomes, and Support from the Literature and/or Guidelines

Intervention	Outcome(s)	Studies	Population	Evidence	Guidelines
Preoperative
Patient education	↓ LOS; ↓ complications	2 MAs (indirect evidence)	CR surgery	+*	√†
Immediate preoperative
Bowel preparation (PO antibiotic and MBP)	↓ SSI	1 MA	CR surgery	+‡	√§
Preoperative (home) bathing	↓ SSI	1 MA, 1 SR	All surgery	−‖	√§
Preoperative VTE prophylaxis	↓ VTE		CR surgery	+/−¶	√†
Intraoperative
Skin preparation	↓ SSI	2 MAs	Clean and clean-contaminated surgery	+‡	√†
(Laparoscopic) surgical technique	↓ LOS; ↓ complications; faster return of bowel function	4 MAs	CR surgery	+‡	√†
Minimization of tubes/drains	- anastomotic dehiscence; -SSI; - reoperation; -mortality	4 MAs, 1 SR	CR surgery	+‡	√†
Postoperative
Early mobilization	↓/− LOS; +/− faster return of bowel function	1 SR	Abdominal surgery	+/−¶	√†
Early alimentation	↓ LOS; ↓ complications; −/↓ mortality	4 MAs, 1 SR	Abdominal surgery	+‡	√†
Early urinary bladder catheter removal	↓ UTI	2 MAs, 1 SR	CR surgery	+‡	√†
Early IV fluid discontinuation	↓ LOS; ↓ complications	1 MA	Abdominal and CR surgery	+‡	√†
Postoperative VTE prophylaxis	↓ VTE	1 MA	All and CR surgery	+‡	√†
Glucose management	↓ SSI	1 MA	All and CR surgery	+‡	√†

^*Designates a component where evidence was indirect, but supported given practice

^†Designates a component where all guidelines supported a given practice

^‡Designates a component where all evidence supported a given practice

^§Designates a component where some, but not all, guidelines supported a given practice

^‖Designates a component where evidence showed no effect of a given practice

^¶Designates a component where evidence was mixed (some showing benefit, some showing no effect) regarding a given practice

LOS, length of stay; SSI, surgical site infection; VTE, venous thromboembolism; UTI, urinary tract infection; SR, systematic review; MA, meta-analysis; CR, colorectal