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Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs.
Eur Urol. 2016 07; 70(1):176-187.EU

Abstract

CONTEXT

Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times.

OBJECTIVE

To overview the use and key elements of ERAS pathways, and define needs for future clinical trials.

EVIDENCE ACQUISITION

A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms "postoperative period," "postoperative care," "enhanced recovery after surgery," "enhanced recovery," "accelerated recovery," "fast track recovery," "recovery program," "recovery pathway", "ERAS," and "urology" or "cystectomy" or "urologic surgery."

EVIDENCE SYNTHESIS

We identified 18 eligible articles. Patient counseling, physical conditioning, avoiding excessive alcohol and smoking, and good nutrition appeared to protect against postoperative complications. Fasting from solid food for only 6h and perioperative liquid-carbohydrate loading up to 2h prior to surgery appeared to be safe and reduced recovery times. Restricted, balanced, and goal-directed fluid replacement is effective when individualized, depending on patient morbidity and surgical procedure. Decreased intraoperative blood loss may be achieved by several measures. Deep vein thrombosis prophylaxis, antibiotic prophylaxis, and thermoregulation were found to help reduce postsurgical complications, as was a multimodal approach to postoperative nausea, vomiting, and analgesia. Chewing gum, prokinetic agents, oral laxatives, and an early resumption to normal diet appear to aid faster return to normal bowel function. Further studies should compare anesthetic protocols, refine analgesia, and evaluate the importance of robot-assisted surgery and the need/timing for drains and catheters.

CONCLUSIONS

ERAS regimens are multidisciplinary, multimodal pathways that optimize postoperative recovery.

PATIENT SUMMARY

This review provides an overview of the use and key elements of Enhanced Recovery after Surgery programs, which are multimodal, multidisciplinary care pathways that aim to optimize postoperative recovery. Additional conclusions include identifying effective procedures within Enhanced Recovery after Surgery programs and defining needs for future clinical trials.

Authors+Show Affiliations

Urology Department, King Abdulaziz University, Jeddah, Saudi Arabia; USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: raazhar@kau.edu.sa.Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.Academic Units of Urology and Molecular Oncology, University of Sheffield, Sheffield, South Yorkshire, UK.Department of Urology, Houston Methodist Hospital, Houston, TX, USA.Division of Surgery and Interventional Science, UCL Medical School, University College London, London, UK.James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.Department of Urology, University Hospital Inselspital, Bern, Switzerland.USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

26970912

Citation

Azhar, Raed A., et al. "Enhanced Recovery After Urological Surgery: a Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs." European Urology, vol. 70, no. 1, 2016, pp. 176-187.
Azhar RA, Bochner B, Catto J, et al. Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs. Eur Urol. 2016;70(1):176-187.
Azhar, R. A., Bochner, B., Catto, J., Goh, A. C., Kelly, J., Patel, H. D., Pruthi, R. S., Thalmann, G. N., & Desai, M. (2016). Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs. European Urology, 70(1), 176-187. https://doi.org/10.1016/j.eururo.2016.02.051
Azhar RA, et al. Enhanced Recovery After Urological Surgery: a Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs. Eur Urol. 2016;70(1):176-187. PubMed PMID: 26970912.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs. AU - Azhar,Raed A, AU - Bochner,Bernard, AU - Catto,James, AU - Goh,Alvin C, AU - Kelly,John, AU - Patel,Hiten D, AU - Pruthi,Raj S, AU - Thalmann,George N, AU - Desai,Mihir, Y1 - 2016/03/09/ PY - 2015/09/12/received PY - 2016/02/17/accepted PY - 2016/3/14/entrez PY - 2016/3/14/pubmed PY - 2017/12/22/medline KW - ERAS KW - Enhanced recovery after surgery KW - Perioperative care SP - 176 EP - 187 JF - European urology JO - Eur. Urol. VL - 70 IS - 1 N2 - CONTEXT: Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times. OBJECTIVE: To overview the use and key elements of ERAS pathways, and define needs for future clinical trials. EVIDENCE ACQUISITION: A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms "postoperative period," "postoperative care," "enhanced recovery after surgery," "enhanced recovery," "accelerated recovery," "fast track recovery," "recovery program," "recovery pathway", "ERAS," and "urology" or "cystectomy" or "urologic surgery." EVIDENCE SYNTHESIS: We identified 18 eligible articles. Patient counseling, physical conditioning, avoiding excessive alcohol and smoking, and good nutrition appeared to protect against postoperative complications. Fasting from solid food for only 6h and perioperative liquid-carbohydrate loading up to 2h prior to surgery appeared to be safe and reduced recovery times. Restricted, balanced, and goal-directed fluid replacement is effective when individualized, depending on patient morbidity and surgical procedure. Decreased intraoperative blood loss may be achieved by several measures. Deep vein thrombosis prophylaxis, antibiotic prophylaxis, and thermoregulation were found to help reduce postsurgical complications, as was a multimodal approach to postoperative nausea, vomiting, and analgesia. Chewing gum, prokinetic agents, oral laxatives, and an early resumption to normal diet appear to aid faster return to normal bowel function. Further studies should compare anesthetic protocols, refine analgesia, and evaluate the importance of robot-assisted surgery and the need/timing for drains and catheters. CONCLUSIONS: ERAS regimens are multidisciplinary, multimodal pathways that optimize postoperative recovery. PATIENT SUMMARY: This review provides an overview of the use and key elements of Enhanced Recovery after Surgery programs, which are multimodal, multidisciplinary care pathways that aim to optimize postoperative recovery. Additional conclusions include identifying effective procedures within Enhanced Recovery after Surgery programs and defining needs for future clinical trials. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/26970912/Enhanced_Recovery_after_Urological_Surgery:_A_Contemporary_Systematic_Review_of_Outcomes_Key_Elements_and_Research_Needs_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(16)00241-4 DB - PRIME DP - Unbound Medicine ER -