Table 1.

Indicators used to assess compliance with the ERAS components

ERAS components	Summary of the recommendations
1. Preoperative counseling and patient education	Prior to admission, every patient was consulted at least once by an anesthetist and at least twice by a surgeon in the outpatient clinic. Verbal and written education regarding the ERAS components were provided to patients at a dedicated preadmission visit
2. Preoperative optimization	Preoperative assessment was performed to identify and adjust for risk factors/medical conditions that affect recovery. Patients were advised to quit smoking, stop drinking alcohol and begin physical exercises according to their physical status before admission
3. Preoperative nutritional screening and support	Patients at risk (NRS-2002 score ≥ 3) should receive oral nutritional supplements for 5–7 days prior to surgery. For severely malnourished patients, surgery should be postponed for at least 2 weeks to improve their nutritional status
4.Avoid bowel preparation	No bowel preparation should be performed
5. Avoid fasting	Free diet is allowed; fast from solid foods for 6 h before surgery and consume only liquid food (no milk or beverages containing fat); high-carbohydrate clear fluids until 2 h prior to surgery
6. Preoperative carbohydrate loading	Two to three hours prior to surgery, the patients received 200 ml of a clear carbohydrate-rich drink prepared by the nutrition department of our hospital (ingredients: glucose 0.8 g, fructose 5.2 g, maltose 2.8 g, maltodextrins 40 g, protein 0 g, fat 0 g, potassium 0 mg, sodium 3 mg, calcium 0 mg, dietary fiber 0 g, energy 193 kcal; 260 mOsm/(kg·H2O), pH = 4.9)
7. Avoidance of preanesthetic medications	Long-acting anxiolytic drugs should be avoided. Short-acting anxiolytics may be used for regional analgesia prior to the induction of anesthesia
8. Antimicrobial prophylaxis	A single intravenous dose of cefoxitin (2 g, 30 min) is provided before surgery
9. Preoperative prophylactic analgesia	Oral celecoxib (200 mg) is provided in the evening prior to surgery Intravenous analgesic of parecoxib (40 mg) is provided prior to surgery
10. Avoidance of a nasogastric tube	No nasogastric tube is placed, or the nasogastric tube is removed at the end of the anesthesia period
11. Prevention of intraoperative hypothermia	Intraoperative normothermia is maintained at 36.5 ± 0.5 °C using a warm air-circulating blanket
12. Laparoscopic surgery	A laparoscopic approach was used
13. No routine abdominal drainage	Avoidance or early removal of abdominal drainage tubes is recommended
14. No routine urinary catheter	Avoidance or early removal of urinary catheters on POD1 is recommended
15. Multimodal postoperative analgesia plan	POD 0: PCA + NSAIDS every 12 h + opioids i.m. as necessary; POD 1–3: removal of PCA, NSAIDS i.v. every 12 h, occasional NSAIDs i.v. or opioids i.m. only when necessary. Starting on POD4: discontinuation of NSAIDS i.v. every 12 h, occasional NSAIDs i.v. or opioids i.m. only when necessary
16. Postoperative early oral intake	An oral nutritional supplement prepared by the nutrition department of our hospital is provided 6 h postoperatively; light hospital diet and oral nutritional supplements are provided on the first postoperative day; and a full hospital diet is provided on the second postoperative day
17. Postoperative nutritional screening and support	According to the NRS-2002 score, individualized postoperative enteral or parenteral feeding should be reserved for malnourished patients or those with prolonged fasting due to complications
18. First 24-h fluid balance < 2000 ml	Defined as a fluid balance less than 2000 ml in the first 24 h after the end of surgery
19. Antithrombotic prophylaxis	Prophylaxis is provided using an intermittent pneumatic compression device, compression stockings and low-molecular-weight heparin
20. Early mobilization	Early walking is encouraged in the first 24 h postoperatively (getting out of bed, going to the bathroom, walking along the corridor, spending at least 4 h out of bed)

ERAS enhanced recovery after surgery, NRS-2002 nutritional risk screening 2002, POD postoperative day, PCA patient-controlled analgesia, NSAIDs nonsteroidal anti-inflammatory drugs, i.v. intravenous, i.m. intramuscular