Enhanced recovery after surgery review and urology applications in 2020

Abstract

Purpose: To explore enhanced recovery after surgery (ERAS) components and their current application to major urologic surgeries, barriers to implementation and maintenance of the associated quality improvement. Data Identification: An English language literature search was done using PubMed. Study Selection: After independent review, 55 of the original 214 articles were selected to specifically address the stated purpose. Data Extraction: Clinical trials were included, randomized trials were prioritized, but robust observational studies were also included. Results of Data Synthesis: Many ERAS components have good data to support usage in radical cystectomy (RC) patients. Most ERAS programs include multidisciplinary teams carrying out multimodal pathways to hasten recovery after a major operation. ERAS components generally include preoperative counseling and medical optimization, venous thromboembolism prophylaxis, ileus prevention, avoidance of fluid overload, normothermia maintenance, early mobilization, pain control and early feeding, all leading to early discharge without increased complications or readmissions. Although there may not be specific data pertaining to other major urologic operations, the principles remain similar and ERAS is easily applicable. Conclusion: The benefits of ERAS programs are well established for RC and principles are easily applicable to other major urology operations. Barriers to implantation and maintenance of ERAS must be recognized to continue to maintain the benefits of these programs.

Wound infiltration or transversus abdominis plane block after laparoscopic radical prostatectomy: a randomized clinical trial

“…Effective pain management is key for optimal postoperative recovery and an essential component of enhanced recovery protocols [20]. However, direct high-level evidence is often lacking to support an optimal approach, even in commonly performed procedures, such as laparoscopic prostatectomy.…”

This Month in Pediatric Urology

“…This multimodal approach includes preoperative, perioperative, and postoperative interventions. 1 Preoperative education, medical optimization and nutrition, correcting high blood pressure and anemia, controlling diabetes, physical exercise, and smoking cessation are common preoperative goals. The nature of the bowel prep has been modified, with new variations in fasting times and preoperative carbohydrate loading.…”