Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

Table 1 Enhanced recovery after surgery elements

Preoperative	Pre-admission counseling
	Stopping smoking and alcohol abuse
	Optimize nutrition and glucose control
	No oral bowel preparation
Intra-operative	Preoperative carbohydrate loading
	Avoiding sedative premedication
	Thromboembolism and antimicrobial prophylaxis
	Epidural or other regional anesthesia
	Balanced fluid therapy avoiding overhydration
	Active warming
	Minimally invasive surgery
	PONV prophylaxis
	No abdominal drains or nasogastric drains
Postoperative	Multimodal analgesia to avoid opioids
	Early removal of urinary catheter
	Early oral feeding and intense mobilization
	No intravenous infusions
	Support of GI function (laxatives/prokinetics)
	Nutritional supplements
	Audit

PONV: Postoperative nausea and vomiting; GI: Gastrointestinal.

Table 2 Key points in this paper

Key points
Traditional unstructured perioperative care is still common
The ERAS protocol is an evidence-based structured perioperative regime
The ERAS program improves postoperative recovery and reduces morbidity
More research is needed on cost-effectiveness, long-term outcomes,
quality of life, and patient-related outcomes
Regional and national strategies to support the implementation of evidence-based perioperative care in general health care are warranted