Table 3.

Summary of Guidelines Supporting Improving Surgical Care and Recovery Protocol Components

Intervention	Guideline	Year	Recommendation
Preoperative
Patient education	ERAS Society⁴⁰	2013	Routine preoperative patient education recommended as it can only be beneficial.
Immediate Preoperative
Bowel preparation (PO antibiotic and MBP)	ACS/SIS SSI Guidelines⁴²	2016	Combination mechanical and PO antibiotic bowel preparation recommended for elective colorectal surgery.
	ERAS Society⁴⁰	2013	Recommends against routine use of mechanical bowel preparation alone.
	SHEA/IDSA Practice Recommendation⁴³	2013	Mechanical bowel preparation alone is not recommended. Reduction in SSI has been shown with combined mechanical and PO antibiotic bowel preparation.
Preoperative (home) bathing	ACS/SIS SSI Guidelines⁴²	2016	Chlorhexidine bathing reduces skin surface pathogen counts, but has not been shown to reduce SSI.
	HICPAC[personal communication with Dr. Bratzler]	Update pending	Bathing with soap or an antiseptic agent is recommended the night before the operative day.
Preoperative VTE prophylaxis	American College of Chest Physicians⁴⁴	2012	Preoperative administration of VTE chemoprophylaxis is recommended.
	American Society of Clinical Oncology⁴⁵	2013	VTE chemoprophylaxis with low-dose unfractionated heparin or low molecular weight heparin is recommended for patients undergoing major cancer surgery beginning preoperatively and continuting until POD 7–10.
	European Society of Medical Oncology⁴⁶	2011	Postop VTE prophylaxis options include compression stockings and chemoprophylaxis with low-dose unfractionated heparin and low molecular weight heparin.
Intraoperative
Skin preparation	ACS/SIS SSI Guidelines⁴²	2016	Preparation with an alcohol-containing agent is recommended. No superior agent (chlorhexidine vs. iodine) when combined with alcohol. If alcohol cannot be included in the preparation, chlorhexidine should be used instead of iodine unless contraindications exist.
	ERAS Society⁴⁰	2013	Chlorhexidine-alcohol is recommended over iodine alone for skin preparation.
	SHEA/IDSA Practice Recommendation⁴³	2013	Skin preparation with an alcohol-containing agent is recommended unless contraindications exist.
(Laparoscopic) surgical technique	ERAS Society⁴⁰	2013	Laparoscopic surgery is recommended if the expertise is available.
Minimization of tubes/drains	ERAS Society⁴⁰	2013	Routine postoperative nasogastric drainage and abdominal drainage are not recommended.
Postoperative
Early mobilization	ERAS Society⁴⁰	2013	Prompt postoperative mobilization is recommended as prolonged bedrest has been shown to be harmful.
Early alimentation	ERAS Society⁴⁰	2013	Patients should be encouraged to take normal food as soon as possible after surgery.
Early urinary bladder catheter removal	ERAS Society⁴⁰	2013	Urinary catheter removal is recommended between POD 1–2, even in the presence of a thoracic epidural.
	HICPAC⁴⁷	2009	Urinary catheter removal within 24 hours of surgery is recommended.
Early IV fluid discontinuation	ERAS Society⁴⁰	2013	Early initiation of PO fluid intake is recommended, as is early discontinuation of IV fluids if patient is tolerating PO.
Postoperative VTE prophylaxis	ASCRS Guidelines⁴⁸	2006	Chemical thromboprophylaxis is recommended for all patients undergoing CR surgery, and addition of mechanical thromboprophylaxis is recommended in high-risk patients. Patients with cancer should receive posthospital prophylaxis with LMWH.
	ERAS Society⁴⁰	2013	Combined chemical and mechanical thromboprophylaxis is recommended for all patients. Extended chemical prophylaxis for 28 days is recommended for patients with cancer.
	NICE Guidelines⁴⁹	2010	At-risk patients should receive combined mechanical and chemical thromboprophylaxis.
Glucose management	ACS/SIS SSI Guidelines⁴²	2016	Blood glucose between 110–150 mg/dL is recommended for all patients regardless of diabetic status to reduce SSI.
	ERAS Society⁴⁰	2013	Hyperglyemia increases the risk of SSI and should be avoided.

MBP, mechanical bowel preparation; VTE, venous thromboembolism; ERAS, Enhanced Recovery after Surgery; ACS, American College of Surgeons; SIS, Surgical Infection Society; SHEA, Society for Healthcare Epidemiology of America; IDSA, Infectious Diseases Society of America; HICPAC, Healthcare Infection Control Practices Advisory Committee; ASCRS, American Society of Colon and Rectal Surgeons; NICE, National Institute for Health and Care Excellence