Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2025

Preoperative ERAS items Preadmission education and informationPreoperative education is a crucial component of ERAS care in colorectal surgery, but its wide variation makes comparing studies challenging.From 3,512 publications identified in the literature search, 10 met grading criteria, including 3 moderate-quality randomized controlled trials (RCTs).One RCT 9 found that tailored information for patients with rectal cancer reduced anxiety and improved satisfaction, especially 6 months after surgery.Another RCT 10 showed that virtual reality education significantly decreased anxiety and depression, enhancing patient satisfaction.A third RCT 11 reported that targeted preoperative ERAS and stoma education shortened hospital stays from 9 to 6 days, recommending early, repeated education by nurse specialists.Seven additional lowquality studies supported the value of focused educational interventions in varied contexts. Quality of evidence and recommendations.Recommendation: Preadmission education and information should be provided to all patients before surgery.Quality of evidence: Preadmission education and information.Quality of life: Moderate evidence for reduction in anxiety.Low evidence to support improvements to quality of life.Length of stay: Low evidence to correlate preadmission information as an independent component leading to reduction of LOS.Recommendation grade: Strong. Preoperative optimizationPreoperative optimization is complex, involving diverse interventions.It focuses on reducing risks and comorbidities before surgery while enhancing health through strategies such as alcohol cessation and physical training.Preoperative optimization can be divided into 6 key components. Identification of high-risk patients.There are several predictive tools that have been validated in colorectal surgery to identify patients at greatest risk for adverse outcomes.The evidence for specific tools is, however, weak.The American Society of Anesthesiologists Physical Status Classification System 12 and the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator 13 are the tools with the best evidence in predicting outcomes from surgery.These platforms have been widely adopted globally, suggesting feasibility and acceptability. Quality of evidence and recommendations.Recommendation: Predictive tools should be used to identify high-risk patients before colorectal surgery to optimize perioperative planning and preparation.Quality of evidence: Using predictive tools.Mortality: Very low.Complications: Very low