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Table 1 Components of non-ERAS Traditional care program and ERAS program

From: Comparative short-term outcomes of enhanced recovery after surgery (ERAS) program and non-ERAS traditional care in elderly patients undergoing lumbar arthrodesis: a retrospective study

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