**2. Components of ERAS**

There are 24 components of ERAS that are used by different surgical specialties of the hospital for different patients (**Table 1**) [8].

#### **2.1 Preadmission**

#### *2.1.1 Preadmission information, education, and counseling*

It is recommended that proper preoperative counseling should be done as it not only takes out the fear of surgery but also helps in pain control to a reasonable amount which ultimately will lead to an early discharge for the patient [14–18]. Patient education via leaflets, drawings, and multimedia (like various videos) of the surgical

#### *Enhanced Recovery after Surgery DOI: http://dx.doi.org/10.5772/intechopen.110343*


#### **Table 1.**

*ERAS guidelines 2018 for colorectal surgery (http://www.erassociety.org) [8].*

procedures also improves pain and anxiety after surgery. Patients should always be designated a particular role post-surgery, including proper nutrition and mobilization [14, 19, 20]. The grade of recommendation is strong.

#### *2.1.2 Preoperative optimization: (risk assessment, abstinence of smoking and alcohol)*

Preoperative risk assessment of the patient should be done along with optimization of heart, lung, and kidney diseases, diabetes, hypertension, anemia, malnutrition, and cessation of excessive alcohol and smoking. Smokers have an increased risk of intraoperative and postoperative complications [21]. Counseling and nicotine replacement are very effective methods in preoperative smoking cessation [22]. At least 4–8 weeks of abstinence is required to reduce respiratory and wound healing complications [23, 24]. Alcohol abuse increases postoperative morbidity but not mortality. At least four weeks of abstinence is required [25]. The grade of recommendation for preoperative optimization is strong.
