Table 1 ERAS items compared to the perioperative measures adopted in the conventional care

Preadmission information, education, and counseling (dedicated preoperative counseling about ERAS protocol)

Not applicable

Preoperative optimization (increasing preoperative exercise and avoid smoking and drinking alcohol 1-month prior surgery)

None

Preoperative fasting and carbohydrate loading (fluid up to 2 h and solid up to 6 h prior of induction of anesthesia, preoperative carbohydrate loading)

Preoperative fasting 12 h prior of induction of anesthesia

Preoperative thromboprophylaxis with LMWH; extended prophylaxis for 28 days for colorectal cancer patients

Same protocol

Avoid pre-anesthetic medication (midazolam) or, if necessary, administer short-acting intravenous drugs

Pre-anesthetic medication routinely used

Antimicrobial prophylaxis (preoperative intravenous antibiotics) and skin preparation

Antibiotic prophylaxis prolonged for 48 h postoperatively

Multimodal approach to PONV preoperatively (minimal preoperative fasting, carbohydrate loading), intraoperative (anesthetic PONV prevention), and postoperatively (add antiemetic that were not used for prophylaxis)

Treating PONV with antiemetics only once has already appeared

Standard anesthetic protocol allowing rapid awakening

None

Perioperative fluid management (balanced crystalloid, intraoperative fluids administration guided by flow measurements in open surgery, vasopressor in management of epidural-induced hypotension, early enteral administration of fluids)

Balanced crystalloid

Preventing intraoperative hypothermia (intraoperative maintenance of normothermia with warming device and warmed intravenous fluid to keep temperature > 36 °C)

Use of warmed intravenous fluid

Minimally invasive surgical access recommended (7/9 surgeon MIS trained)

Few surgeons (2/9) MIS trained

Drainage of the peritoneal cavity and pelvis (routine drainage discouraged, early removal in POD 1/2 when no blood or purulent output)

Abdominal drainage routinely used, removed when output < 100 ml

Nasogastric Intubation not inserted, unless gastric distension in presence of bowel occlusion

Nasogastric tube routinely used and removed when output < 200 ml/day

Postoperative analgesia (FANS +/- Tap block)

PCA with morfine

Urinary drainage (not routinely used, removed when possible after postoperative day 1/2) T4 patients with pelvic mass or with bladder involvement are considered high risk for urinary retention, therefore maintained urinary catheter at least until day 3

Urinary catheter removal after postoperative day 4/5 or when patients were able to mobilize

Postoperative glycemic control (use of stress reducing element of ERAS to minimize hyperglycemia, insulin treatment in ICU and ward setting when required)

Standard glycemic control

Postoperative nutritional care (postoperative early enteral feeding and nutritional screening)

Enteral feeding resumed when bowel movement present and nasogastric tube output < 100 ml

Early mobilization within first postoperative day. Patient’s counseling, dedicated nursing staff, and physiotherapists to early mobilization

Mobilization after removal of Foley catheter. Never before postoperative day 3