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Colorectal - Enhanced Recovery Surgical Innovation

Before Surgery (At Home)

Enhanced Recovery -Surgical Innovation Patient Education Packet

Pre-admission Testing

  • You will need to undergo a history and physical and have blood work completed in order to be cleared for surgery.
  • We Highly Recommended GBMC’s Pre-admission Testing Department; otherwise, this can be done by your primary care physician.
  • Visit Perioperative Testing Center at GBMC


  • We recommend you increase your exercise by at least 10% prior to surgery. You can do this by simply walking 30 minutes a day.
  • Your Doctor may refer you to a physical therapist or exercise program depending on your diagnosis and procedure.
  • Visit ActiveLife Website


Carbohydrate Drink

  • You can consume clear liquids up to two hours prior to surgery.
  • Clear liquids include water, jello, juice without pulp, clear borth, Gatorade, tea, or coffee without milk.
  • You will consume one Clear Carbohydrate drink before bed the night before surgery
  • You will consume an additional Clear Carbohydrate drink the morning of surgery on your way to the hospital.
  • Carbohydrate loading diminishes pre-operative thirst, hunger, and anxiety resulting in reduced post-operative dehydration, insulin resistance, and fatigue.
  • **Do not consume the Clear Carbohydrate the morning of surgery if you are pregnant or have a history of Diabetes, Gastroesophageal Reflux Disease (GERD), Body Mass Index (BMI)>39.
  • BMI Calculator

CHG/Hibiclens Wash

  • You will be instructed to shower using CHG/Hibiclens wash the night before and the morning of surgery.
  • If you are allergic to CHG/Hibiclens wash, you will be instructed to use a product known as Theraworx.
  • The solution kills bacteria on the skin that could cause a wound infection after surgery.
  • How to use Hibiclens wash

Deep Breathing Exercise and/or Incentive Spirometry

Before Surgery (Pre-Operatively)

CHG/Theraworx Wipes

  • You will be instructed to use CHG wipes or Theraworx wipes (if allergic to CHG) at the hospital in pre-op before surgery.
  • The solution kills bacteria on the skin that could cause a wound infection after surgery.

Pain Management

  • Pain will be addressed using oral medications that target several different pain receptors.

Warming Gown

  • You will receive a purple warming gown to keep you comfortable and help maintain your temperature through the surgical process.

During Surgery

Antibiotic Prophylaxis

  • Will be given within 1 hour of incision

Standardized Anesthesia Care

  • Evidence-based, best practice recommendations will be used throughout surgery.
  • These standardized anesthetics will be focused on non-narcotic pain medications, and often utilizes local anesthetic pain blocks for the best possible pain relief.

After Surgery

Post-operative Pain Management

  • Pain will be addressed using oral medications that target several different pain receptors.

Tubes and Catheters

  • The nasogastric tube and Foley catheter should be removed on postoperative day 1, unless specified by the surgical team.


  • You should be out of bed and walking by postoperative day 1.
  • Daily ambulation goals will be set by the medical team and their completion encouraged by nursing staff.

Eating and Drinking

  • Day 1 after surgery, we will place you on a clear liquid diet and encourage gum chewing as well as high protein supplements.
  • We will advance your diet with solid food as tolerated. Proper nutrition will allow for improved recovery and reduce your risk for surgical infection.
  • The goal is to get your diet advanced to solid food as quickly as we can, once you are medically able to.

Education Materials

Our Team

Joseph D. DiRocco, MD
Joseph D. DiRocco, MD
Physician Champion
George Y Apostolides, MD
George Y. Apostolides, MD
Physician Champion
Kara Douglas, CRNA
Kara Douglas, MSN, APN, CRNA
Program Director
Rachel Hellmann MSN, RN, CNOR
Rachel Hellmann MSN, RN, CNOR
Clinical Program Manager
  • John L. Flowers, MD
  • Francis S. Rotolo, MD
  • Joel A. Turner, MD
  • Timothee J. Friesen, MD
  • Laurence H. Ross, MD
  • Francesco Grasso, MD
  • Nina E. Ferraris, MD
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