Table 1.

What is New in the 2022 ASCRS Enhanced Recovery After Colon and Rectal Surgery Clinical Practice Guidelines

New Recommendations
Preoperative Interventions Preadmission Nutrition and Bowel Preparation 5. Oral nutritional supplementation is recommended in malnourished patients prior to elective colorectal surgery. Grade of recommendation: weak recommendation based on moderate quality evidence, 2B.
Perioperative Interventions Intraoperative Fluid Management 15. Hypotension should be avoided as even short durations of mechanical bowel preparation < 65 are associated with adverse outcomes, in particular myocardial injury, and acute kidney injury. Grade of recommendation: strong recommendation based on moderate quality evidence, 1B.
Postoperative Interventions Discharge Criteria 26. Early discharge prior to return of bowel function may be feasible in low-risk patients undergoing minimally invasive colectomy when coupled with close outpatient communication and follow-up. Grade of recommendation: weak recommendation based on moderate quality evidence, 2B.
Updated Recommendations
Preadmission 6. Mechanical bowel preparation combined with preoperative oral antibiotics is typically recommended prior to elective colorectal resection. Grade of recommendation: strong recommendation based on moderate-quality evidence, 1B.
Pain Control 11. Thoracic epidural analgesia, while not recommended for routine use in laparoscopic colorectal surgery, is an option for open colorectal surgery if a dedicated acute pain team is available for postoperative management. Grade of recommendation: strong recommendation based on moderate-quality evidence, 1B.
Fluid Management 13. Fluid administration should be tailored to avoid excessive fluid administration and volume overload or undue fluid restriction and hypovolemia. Grade of recommendation: strong recommendation based on high-quality evidence, 1A.
Fluid Management 14. Balanced chloride-restricted crystalloid solutions should be used for maintenance infusions and fluid boluses in patients undergoing colorectal surgery. There is no benefit to the routine use of colloid solutions for fluid boluses. Grade of recommendation: strong recommendation based on moderate-quality evidence, 1B.
Fluid Management 16. In high-risk patients and in patients undergoing colorectal surgery with significant intravascular losses, the use of goal-directed hemodynamic therapy may be considered. Grade of recommendation: weak recommendation, based on moderate-quality evidence, 2B
Postoperative Management 25. Urinary catheters should typically be removed within 24-48 hours after mid/lower rectal resection. Grade of recommendation: strong recommendation based on moderate quality evidence, 1B.