Outcomes of ERAS in Urological Surgery

黄建宏

Outcomesof ERAS in Urological Surgery

CurrentERAS protocols include >20 elements and reduce bothmorbidity and LOS. The successful use of modified ERAS protocols has been reported forradical cystectomy.

Maffezzini etal (1). applied 6 of 22 ERAS items to 71 patients undergoing radicalcystectomy. When compared with historical controls, patients with ERAS had areduced LOS (from 22 d to 15 d) without worsening morbidity.

Arumainayagamet al (2). compared 56 consecutive patients undergoing open radical cystectomywith standard perioperative care with 56 patients after implementation of ERAS.Morbidity was similar in the two groups, but LOS was significantly reduced (from17d to 13 d) in the enhanced recovery group.

Pruthi et al(3). reported the implementation of ERAS after cystectomy. When compared withhistorical controls, the most recent 100 patients had better postoperativerecoveries.

ERAS pathwaysclearly improve patient care, reduce morbidity, and shorten LOS. All studiesevaluating elements of the ERAS care pathways in radical cystectomy have found benefitsin postoperative morbidity, return to bowel function, or LOS (4).

Multicenterprospective studies using a centralized database are needed to prove  the real benefits of full ERAS protocols onmorbidity, mortality, LOS, readmission rate, and costs.

References:

1. MaffezziniM, Gerbi G, Campodonico F, Parodi D. Multimodal

perioperativeplan for radical cystectomy and intestinal urinary diversion. I. Effect onrecovery of intestinal function and occurrence

ofcomplications. Urology 2007;69:1107–11.

2. ArumainayagamN, McGrath J, Jefferson KP, Gillatt DA. Introduction

of anenhanced recovery protocol for radical cystectomy. BJU Int2008;101:698–701.

3. Pruthi RS,Nielsen M, Smith A, Nix J, Schultz H, Wallen EM. Fast track

program inpatients undergoing radical cystectomy: results in 362 consecutivepatients. J Am Coll Surg 2010;210:93–9.

4. Patel H, CerantolaY , Valerio M, Persson B, Jichlinski P, Ljungqvist O, et al: EnhancedRecovery After Surgery: Are We Ready, and Can We Afford Not to Implement ThesePathways for Patients Undergoing Radical Cystectomy? EuropeanUrology 2 0 1 4; 65: 2 6 3 – 2 6 6