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| Preoperative measures | Intraoperative measures | Postoperative measures |
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| Patient and family education | Blood-loss prevention | Analgesia |
| (i) By multidisciplinary team (nursing, physicians, and allied healthcare staff) | (i) Wider use of tranexamic acid and assurance of normothermia | (i) Parenteral multimodal analgesia: IV paracetamol (1 gm q6h) and IV morphine 0.1 mg/kg PRN for up to 24 hours |
| (ii) Clear plan for perioperative care, operative protocol, and postoperative management | (ii) Wider use of bipolar cautery, topical hemostatic agents, and less-invasive posterior approaches | (ii) Alternatively: patient-controlled analgesia |
| (iii) Discharge planning on the day of admission and outpatient follow-up care fully disclosed | (iii) Discourage use of subfascial drains | (iii) Nausea prevention: metoclopramide or ondansetron |
| (iv) Patient is fully aware of the target of 3 days or less for most cases | | (iv) Once the patient is taking well orally, can be switched to oral analgesics (tramadol 50 to 100 mg q8h, paracetamol 1 gm q8h, and gabapentin 300 mg q8h) |
| | | Early mobilization |
| (i) Discontinuation of urinary catheter 6 AM on postoperative day 1 |
| (ii) Mobilization out of early on postoperative day 1 |
| Thromboembolic prophylaxis | Nutrition |
| (i) Routine application of pneumatic compression devices intraoperatively | (i) Early cessation of parenteral fluid and oral feeding |
| (ii) High-risk patients receive chemical prophylaxis | (ii) Routine use of stool-softening agents |
| Infection prevention | Discharge plan |
| (i) Thorough irrigation throughout the procedure | (i) Discharge medications and outpatient appointment prepared for all early morning on postoperative days 2-3 |
| (ii) Local application of vancomycin powder | (ii) Patient and family education regarding activities, use of braces, and medications prior to discharge by the multidisciplinary team |
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