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ENHANCE ERAS® WITH ENCARE
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ERAS® Colorectal Surgery Guidelines 2025 – Key Updates

Eras® colorectal surgery guidelines 2025

The ERAS® Society has released the long-awaited 2025 colorectal surgery guidelines, reflecting the latest evidence and global best practices. These updates refine perioperative care across preoperative, intraoperative, and postoperative phases — adding precision, introducing new recommendations, and adjusting prior guidance where evidence has evolved.

At Encare, we are proud to be the only company working directly with the ERAS® Society and the guideline authors to bring the 2025 colorectal surgery updates into the ERAS® Interactive Audit System (EIAS). This means that EIAS is the only platform globally where hospitals can access, apply, and measure adherence to the most up-to-date ERAS® standards — with full confidence that the content is accurate, validated, and aligned with the experts who wrote the guidelines.

 

Below is a breakdown of the key changes clinicians should be aware of.

Preoperative

  • Risk & Comorbidity
    • Use validated screening tools for high-risk patients.
    • Clearer guidance on optimizing comorbidities.
    • Anemia: routine screening; IV iron + EPO now included.
  • Lifestyle
    • Alcohol cessation: downgraded (weak).
    • Smoking cessation: unchanged, strongly recommended.
    • Prehabilitation: no specific regimen recommended.
  • Nutrition
    • Routine screening mandatory; immunonutrition added for malnourished.
  • Other
    • PONV prophylaxis: expanded optimal regimens.
    • Thromboprophylaxis: intraop IPC + more liberal pharmacologic timing.
    • Bowel prep: MBP alone discouraged (weaker); oral antibiotics emphasized.
    • Carb loading: downgraded (weak, no clinical benefit).

 

Intraoperative

  • Normothermia: methods clarified, strong support remains.
  • Fluids: shift from “near-zero” to slightly positive balance.
  • Surgery: MIS = standard of care.
  • Drainage: still not routine; weaker evidence for rectal resections.

 

Postoperative

  • Tubes/Monitoring
    • NGT: not recommended post-op (evidence downgraded).
    • Glucose control: HbA1c + specific post-op targets included.
  • Fluids: maintain slightly positive balance (≤2.5 kg weight gain).
  • Urinary catheter: remove ≤24h (colonic MIS), ≤48h (rectal MIS).
  • Ileus: multimodal prevention; chewing gum reintroduced.
  • Analgesia: multimodal (acetaminophen, NSAIDs, TAP blocks, intrathecal morphine); epidural alternatives for open surgery now accepted.
  • Nutrition: early oral feeding + supplements; immunonutrition supported.
  • Mobilization: ≥3 hrs/day from POD1 to discharge.

 

Highlights & Take-Homes

  • Precision & detail added: predictive tools, comorbidity optimization, glucose, anemia.
  • Lifestyle advice weakened: alcohol cessation, carb loading, Mechanical Bowel Preparation (MBP) avoidance.
  • Practice shifts: MIS as standard, fluids slightly positive, catheter timing specified.
  • Recovery focus: early feeding, structured mobilization, multimodal ileus & pain prevention.

 

Reference

Gustafsson, U. O., Rockall, T. A., Wexner, S., How, K. Y., Emile, S., Marchuk, A., Fawcett, W. J., Sioson, M., Riedel, B., Chahal, R., Balfour, A., Baldini, G., de Groof, E. J., Romagnoli, S., Coca-Martinez, M., Grass, F., Brindle, M., & Hubner, M. (2025). Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2025. Surgery, 184, Article 109397. https://doi.org/10.1016/j.surg.2025.109397

 

With these updates, the ERAS® Society underscores the ongoing evolution of enhanced recovery, aiming for safer surgery and faster recovery worldwide. Integrated into EIAS, these guidelines become immediately actionable, helping teams measure, compare, and continuously improve patient outcomes.

Learn more about how your hospital can apply the 2025 colorectal protocol in EIAS: Speak with Encare

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