Enhanced Recovery After Surgery (ERAS) protocols have transformed perioperative care. Which of the following is a core ERAS element supported by highest-level evidence that directly reduces length of hospital stay after colorectal surgery?

• A Routine use of nasogastric tube drainage for 24–48 hours post-operatively
• B Preoperative mechanical bowel preparation for all elective colorectal resections
• C Perioperative IV fluids of ≥3L/day to maintain urine output >1 mL/kg/hr
• D Early oral feeding commencing within 24 hours of surgery, multimodal opioid-sparing analgesia, and early mobilisation ✓

Explanation

ERAS (Enhanced Recovery After Surgery) protocols, developed by Henrik Kehlet, are built on high-quality evidence that multimodal interventions reduce the surgical stress response and speed recovery. Core elements with strongest evidence in colorectal surgery include: early oral feeding within 4–24 hours (reduces ileus, infection), multimodal opioid-sparing analgesia (NSAIDs, paracetamol, epidural/TAP blocks), early mobilisation (day of/after surgery), and restrictive IV fluid management (goal-directed, avoiding fluid overload). Routine NG tube drainage and mechanical bowel preparation are specifically contra-indicated in ERAS protocols as they increase complications and delay recovery.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.