Surgical Principles: Improvement Protocols

Surgical Care Improvement Project (SCIP)

Antibiotic Prophylaxis

  • First Generation Cephalosporins (Ancef)
  • Initial Dose: Within 1 Hour Before Incision
  • Second Dose: If Procedure Lasts Over 3 Hours
  • Discontinue: Within 24 Hours After Closure
    • 48 Hours for CABG/Cardiac Surgery

VTE Prophylaxis

  • Initiate Within 24 Hours Postop

Hair Removal

  • Use Clippers (Not Razor – Risk for Infection)

Foley Catheter

  • Remove by Postoperative Day #2

Others Factors

  • Maintain Normothermia Intraoperatively
    • Reduce Infection, Bleeding & Cardiac Complications
  • β-Blockers Should Continue Perioperatively
  • Cardiac Patients Have Controlled AM Glucose < 200

Enhanced Recovery After Surgery (ERAS) Protocol

General

  • Multidisciplinary Evidence Based Protocols
  • Goal to Improve Outcomes & Minimize Pain/Complications

Factors

  • Preoperative
    • Risk Evaluation
    • Patient Education
    • Bowel Prep
    • Fasting Guidelines
    • Smoking Cessation Goal: 4 Weeks
    • Alvimopan Use
  • Intraoperative
    • Anesthetic Selection
    • Lung-Protective Ventilation
    • Fluid Management
    • Temperature Regulation
  • Postoperative
    • Pain Management – Multimodal to Minimize Opioid Use
    • Fluid Management
    • Diet
    • Early Mobilization
    • Early Foley Removal
    • Avoidance of NG Tubes