Table 1 Components of enhanced recovery in spinal surgery, grouped according to perioperative stage of care.

1. Preadmission information, education and counseling

9. Prevention of nausea and vomiting

17. Thromboprophylaxis

2. Risk assessment, preoperative optimization, including lifestyle factor modification

10. Surgical site preparation and antimicrobial prophylaxis

10.1 Surgical site preparation

10.2 Antimicrobial prophylaxis

18. Urinary drainage

2.1 Pre-operative risk stratification

11. Local anaesthetic infiltration

19. Postoperative nutrition and fluid management

2.2 Preoperative assessment and optimization

12. Standard anaesthetic protocol

20. Postoperative glycemic control

2.3 Alcohol use

13.Surgical access (open and minimally invasive spinal surgery, including robotic surgery)

21. Early mobilization

2.4 Tobacco use

14. Maintenance of normothermia

Quality of care measures

3. Prehabilitation

15. Intraoperative fluid and electrolyte therapy

22. Audit

4. Preoperative nutritional care

16. Perioperative analgesia

4.1 Nutritional assessment and screening

4.2 Perioperative immuno-nutrition

5. Management of anaemia

6. Perioperative blood conservation strategies

Preoperative period

7.Preoperative fasting and carbohydrate loading

8.Preemptive analgesia