Comparisons | ERAS Program | non-ERAS Traditional care Program |
---|---|---|
Preoperative | ||
 Education | Including the purpose, workflows and benefits of ERAS program, anticipated postoperative pain and expectations and risks of surgery, through verbal and handouts | Routine consultation |
 Nutritional counselling | Nutrition screening during the perioperative period, including nutrition screening tools and laboratory indicators. Dietitians provide personalized diet guidance and nutritional supplement to patients in need | Not standardized |
 Fasting | Clear fluids including carbohydrate drink allowed up to 2 h before surgery | Fasting for 10 h before surgery |
 Antithrombotic prophylaxis | Active/passive limb movement and antithrombotic stockings | Active/passive limb movement |
 Antimicrobial prophylaxis | Antibiotic prophylaxis within 1 h of incision | Antibiotic prophylaxis within 1 h of incision |
Intra-operative | ||
 Tranexamic acid | Used routinely | Not standardized |
 Standard general anesthetic protocol | Multimodal analgesia; TIVA-based anesthetic technique with propofol, lidocaine, ketamine, ketorolac, antiemetics and with up to 0.5% MAC inhaled anesthetics, avoid N2O; Depth of anesthesia monitoring | Not standardized |
 Avoidance of salt and water overload | Goal-directed euvolemia | Euvolemia |
 Maintenance of normothermia | Keeping core temperature at 36–37 °C | Not standardized |
 local infiltration analgesia | Used routinely | Not standardized |
Postoperative | ||
 Early ambulation | In-bed mobilization within 4 h after surgery; Encourage ambulation after 4 h; Early treatment with physical therapists | Recommended to rest in bed for 1–2 days |
 Early removal of bladder catheter | Remove the bladder catheter when returning to the ward | Remove the bladder catheter when ambulation |
 Early oral feeding | Oral feeding at will after recovery from anesthesia | Oral feeding on postoperative day 1 |
 Postoperative multimodal analgesia | Adequately controlled pain; visual analog scales < 4: no analgesia or oral minimal dose of nonopioid; visual analog scales: 4–6: oral or intravenous nonopioid; visual analog scales ≥7: opioid | According to patient needs; opioid was commonly used |
 Stick to Discharge Criteria | Discharge Criteria: no clinical complications; Visual analog scales <3 with oral analgesics; Independent ambulation or ambulation with minimal assistance; Adequate nutrition intake | No definite discharge criteria |