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SAGES

Reimagining surgical care for a healthier world

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Building Blocks: Preoperative

Click on the title to get more information about this element of the SMART pathway.

An ERP starts in a well functioning preoperative clinic. The goal of preoperative optimization is to improve physiologic reserve to better tolerate the incoming stress of surgery. Nutrition: Patients should be referred to a nutritionist if they are at risk for malnutrition and provided with supplementation to optimize stores preoperatively. Routine use of oral nutritional […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Preoperative

Prehabilitation is a strategy to increase reserve in anticipation of an upcoming stressor. Patients with poor baseline functional capacity are at increased risk of complications and prolonged recovery (1,2). Emerging evidence suggests that a 4-week period of prehabilitation can increase walking capacity in colorectal cancer patients, and deconditioned patients in general make the biggest gains. […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Preoperative

Mechanical bowel preparation has long been thought to reduce infectious complications after colorectal resection. However, mechanical bowel preparation is uncomfortable and results in fluid losses. For colon resection, meta-analyses of randomized trials conclude that mechanical bowel preparation does not decrease infectious complications or leak (1). However, these trials did not include oral antibiotics with the […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Preoperative

Traditionally patients are “NPO after midnight” to reduce the risk of aspiration of gastric contents at induction of anesthesia. This results in a long period without hydration or nutrition, especially for cases booked later the following day. Oral intake of clear fluids up to 2 hours before surgery does not increase the risk of aspiration […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Preoperative

Carbohydrate drink: The administration of a complex carbohydrate-rich drink before surgery (100gm the evening before surgery and 50gm 2-3 hours preop) may increase insulin sensitivity but does not reduce complications or significantly improve other outcomes when compared to placebo fluids (1). Larger trials are required to establish impact on protein catabolism and on clinical outcomes. […]

Posted on
07/01/2015
Surgery Type
Bowel
Building Blocks
Preoperative

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SAGES Enhanced Recovery

SAGES improves quality patient care through education, research, innovation and leadership, principally in gastrointestinal and endoscopic surgery.

Representing a worldwide community of more than 6,000 surgeons, SAGES sets the clinical and educational guidelines on standards of practice in various procedures, critical to enhancing patient safety and health.

SAGES Support

SAGES gratefully acknowledges Medtronic for its generous educational grant in support of the SMART Enhanced Recovery Program.

Preoperative
Intraoperative
Postoperative

SAGES Smart Task Force

  • Liane Feldman, Chair
  • Thomas Aloia, Co-Chair
  • Gina Adrales
  • Rajesh Aggarwal
  • Joselin Anandam
  • Conor Delaney
  • Diana Diesen
  • Justin Dimick
  • Julio Fiore Jr.
  • Gerald Fried
  • Pascal Fuchshuber
  • I. Gorgun
  • Alexis Grucela
  • Matthew Hutter
  • Edmundo Inga-Zapata
  • Rohan Joseph
  • Deborah Keller
  • Anne Lidor
  • David Liska
  • Sumeet Mittal
  • Charles Paget III
  • Michele Riordon
  • Vadim Sherman
  • Andrew Wright
  • Tonia Young-Fadok
  • Yulia Zak
  • Foundation
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  • MyCME
  • Educational Activities

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