Colorectal - Enhanced Recovery Surgical Innovation

Before Surgery (At Home)

Enhanced Recovery -Surgical Innovation Patient Education Packet

• Prior to leaving the surgeon’s office, you will receive your patient education packet.
• Bring your packet to every appointment regarding your surgery.
• Download Enhanced Recovery 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

Prehabiltation

• 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

Nutrition

• A nutrition supplement or nutrition education resources may be recommended depending on your diagnosis or procedure.
• Try to increase your protein intake with supplements. Dairy, meat, beans, legumes, soy products, and eggs.
• Having good nutrition all the way up to the date of surgery will ensure adequate healing afterwards.
• Visit Geckle Diabetes Center at GBMC
• Visit Milton J. Dance Head and Neck Center at GBMC 

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

• You will be instructed to complete deep breathing exercises and/or use an incentive spirometer prior to surgery to keep your lungs healthy.
• Deep Breathing Exercise
• Incentive Spirometry

Before Surgery (Pre-Operatively)

Medication List

• Review list of medications that can and can't be used prior to surgery

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.

Activity

• 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

• Nutrition
• Incentive Spirometry
• Deep Breathing Exercises
• Patient Education Packet
• BMI Calculator
• Ensure Pre-Surgery Clear Carbohydrate Drink
• BAIR Paws Peri-operative Warming Therapy Gown
• Using CHG/Hibiclens Wash
• Using CHG/Theraworx Wipes

Our Team

• 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