Preoperative Assessment and Optimization Evaluation of medication compliance and control of risk factors: hypertension, diabetes, COPD, smoking, alcohol, asthma, CAD, malnutrition, anemia Psychological preparation for surgery and postoperative recovery: provide written information and e-module link including daily milestones in perioperative pathway (diet and ambulation plan, management of drains) and expectation about duration of hospital stay […]
Open Abdominal Surgery ERP POST OPERATIVE/ PACU POST OP DAY 1 POST OP DAY 2 Ketorolac 15-30mg Q 6hr ATC (HOLD FOR POOR RENAL FUNCTION OR BLEEDING) Oral acetaminophen 650mg every 6 hours ATC once able to tolerating oral meds Morphine or hydromorphone PCA (no basal dose) Prophylactic antibiotics ARE NOT CONTINUED, unless specific therapeutic […]
Click to download Colorectal – Perioperative Care (University of Toronto)
Click to download Pain Management (University of Toronto)
Click to download HPB – MD Anderson
Example of patient-friendly information illustrating daily goals for nutrition, pain management, drains, and exercise after bowel surgery. This was created by the McGill Surgical Recovery Group and the McGill University Health Centre (MUHC) Patient Education Office. For each pathway, the same template is used to create patient-friendly materials aligned with procedure-specific daily goals. Image used […]
Table 1 – Summary of the elements of the enhanced recovery program for esophagectomy Pre and Intra-operative Nutritional management Routine nutritionist consultation at time of diagnosis and during neoadjuvant therapy Fast track neoadjuvant chemotherapy to enable greater oral intake (10) Patient education Education booklet provided Web based interactive program provided Pathway is reviewed with patient […]
SAGES SMART steps for creation and implementation of a care pathway Proposed timeline Actions Suggestions 2 weeks Map all care processes involved in perioperative patient care Assemble a multidisciplinary team. Understanding which areas/services are involved with preparing and caring for the perioperative patient will help identify and include all stakeholders. You should have representation of […]
Preoperative Patient attends preoperative visit with surgeon (1-2 weeks prior to surgery) to discuss post-operative course and expectations Patient attends a separate educational class reaffirming short and long term expectations and recognizing complications Patient given binder with all encompassing information related to perioperative journey Patient given post-op scripts and 2 years of follow up appointments […]
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 […]