Table 1 CHASE Enhanced Recovery Protocol.

Preoperative

Dedicated preoperative counseling, which entailed i.e. expectation management by the anesthesiologist;

Baseline assessment with physical examination, electrocardiogram on indication and standard laboratory work-up;

Nutritional screening by dietician, which included the Short Nutritional Assessment questionnaire;

Fasting 6 h prior to surgery for solid food and 2 h prior to surgery for liquids

Oral carbohydrate loading for non-diabetic patients at least 2 h prior to surgery;

Bowel preparation with bisacodyl (2 tablets of 5 mg the night before surgery and 1 tablet the morning of surgery) for patients scheduled for left-sided colon surgery

Patients were admitted at 07:00 AM to the surgical ward; their operation scheduled as second or third operation of the day;

Preoperative analgesia with 1000 mg Paracetamol and 600 mg Gabapentin (300 mg if glomerular filtration rate < 60 ml/min or age > 70 years);

Ambulation to the operation theatre

Intraoperative

Spinal anesthesia (Prilocaine) prior to induction of general anesthesia;

The use of short-acting total intravenous anesthesia (propofol, remifentanil and ketamine (analgesic dosage) in combination with the pre-induction spinal anesthesia;

Restrictive fluid management with continuous perfusion of Ringer Lactate 3 ml/kg/h;

Deep neuromuscular blockade (Rocuronium bromide perfusion)

Lung protective ventilation (Total Volume 6–8 ml/kg; minimum FiO2 and optimal PEEP)

Adequate temperature regulation with forced air warming and core temperature monitoring;

Starting intra-abdominal pressure at 12 mmHg with a gradual decrease to 8 mmHg^29,30

Minimally invasive surgery with intracorporal anastomosis^{31,32,33,34,35,36,37}

Extraction of specimen through a suprapubic Pfannenstiel incision, no additional mini-laparotomy performed³⁸

Postoperative—Directly

Postoperative pain management consisted of Paracetamol(4 × 1000 mg), Meloxicam (1 × 7.5 mg daily for 3 days). If indicated, 5–20 mg Oxynorm (per os) or opioids in the form of Piritramide (intravenously) were given;

Intake and gastro-intestinal motility were stimulated by offering an ice lolly on the recovery ward;

On the surgical ward, intake and mobilization were actively stimulated;

If an urinary catheter was placed; this was removed before 10:00 PM on the surgical ward;

Postoperative day (POD) 1

Routine physical examination by the ward physician;

Evaluation of recovery and readiness for discharge. Patients were considered ‘functionally recovered’ and safe for discharge if they met the following criteria:

Adequate analgesia with oral analgesics, VAS < 4;

No symptoms of nausea or vomiting;

Presence of flatus or the passing of stool;

Oral intake possible;

Spontaneous micturition;

Ability to mobilize independently;

Absence of abnormal vital signs (e.g. fever, tachycardia, hypotension, dyspnea or somnolence)

Expectation management regarding postoperative recovery and provision of an information booklet about postoperative recovery

After discharge

Telephonic aftercare was conducted by the nurse on the evening of discharge (POD 1) and by the nurse practitioner on postoperative day 4 to evaluate recovery and assess the presence of abnormal vital signs;

Appointment in outpatient clinic one week after discharge to receive the pathology results and consequent treatment plan

Evaluation of patients’ experience with the CHASE protocol (see Supplementary form S1.1)