Implementation and sustainability of an enhanced recovery pathway in pediatric bladder reconstruction: Flexibility, commitment, teamwork

Chan, Yvonne Y.; Chu, David I.; Hirsch, Josephine; Kim, Soojin; Rosoklija, Ilina; Studer, Abbey; Brockel, Megan A.; Cheng, Earl Y.; Raval, Mehul V.; Burjek, Nicholas E.; Rove, Kyle O.; Yerkes, Elizabeth B.

doi:10.1016/j.jpurol.2021.08.023

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…Results from pediatric urology also demonstrated complication rates that were not worse compared to pre-ERAS cohorts (33). In fact, ERAS has been associated with fewer bowel-associated and total complications, with similar rates of postoperative emergency department visits, readmissions, and reoperations (4,9,10,56). These robust data support ERAS as a tool to promote QI and patient safety.…”

Section: Complicationsmentioning

confidence: 73%

“…Similarly, drain placement has not been associated with improved outcomes in select pediatric surgeries, including upper urinary tract reconstruction (53)(54)(55). Numerous studies in pediatric urology have successfully incorporated this component into their enhanced recovery protocols without an increase in adverse events, further supporting the safety of this approach (8,10,50,56). Current evidence seems poised to obviate operative drain placement in many pediatric urologic procedures.…”

Section: Minimizing Placement Of Tubes and Drainsmentioning

confidence: 99%

“…While the obstacles to implementing such an extensive protocol may seem numerous, they must be weighed against the benefits for patient care and safety. A QI initiative to implement enhanced recovery pathways in 20 children undergoing bladder reconstruction demonstrates the feasibility of such an endeavor and highlights the assets of this approach (56). Designated champions communicated changes to their teams and met regularly for audits.…”

Section: Barriers and Future Directionsmentioning

confidence: 99%

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The role of enhanced recovery after surgery (ERAS) in promoting quality improvement and patient safety in pediatric urology

Ha,

Harris,

Brockel

et al. 2023

Front. Urol.

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Enhanced Recovery After Surgery (ERAS) is a set of evidence-based, multidisciplinary protocols that aim to improve the perioperative experience for patients by optimizing factors before, during, and after surgery. Originally developed for adult colorectal surgery, these protocols have expanded and been adopted into the pediatric surgical realm, including pediatric urology. Preoperative interventions are directed toward reducing physiologic and emotional stress prior to surgery, including preoperative education and decreased duration of fasting. Intraoperative interventions are designed to support physiologic homeostasis through maintenance of normothermia and euvolemia, use of regional anesthesia, and minimizing placement of drains. Postoperative interventions seek to reduce the physiologic burden of surgery and restore patients to their functional baseline through early oral intake, early mobilization, and opioid-sparing, multimodal analgesia. ERAS has demonstrated efficacy and safety across a wide variety of surgical subspecialties. In pediatric urology, ERAS has led to earlier return of bowel function, decreased opioid utilization, and shorter hospital length of stay, without an increase in complications compared to prior standard of care. ERAS can thus be seen as a system through which quality improvement (QI) initiatives can be designed and tailored to particular settings and patient populations. This review aims to summarize current data in pediatric urology regarding ERAS elements in the context of QI and patient safety. It will discuss the barriers and future directions of this field, including collaboration with implementation science to facilitate adoption of these protocolized measures more widely.

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Section: Complicationsmentioning

confidence: 73%

Section: Minimizing Placement Of Tubes and Drainsmentioning

confidence: 99%

Section: Barriers and Future Directionsmentioning

confidence: 99%

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The role of enhanced recovery after surgery (ERAS) in promoting quality improvement and patient safety in pediatric urology

Ha,

Harris,

Brockel

et al. 2023

Front. Urol.

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“…Within urology, ERAS has shown improved patient experience, faster recovery, and fewer complications in both children and adults. [10][11][12][13][14] Yet, there are no guidelines or published studies that discuss ERAS principles in the BE population. We describe our institution's implementation and evolution of a CPRE-ERAS pathway.…”

mentioning

confidence: 99%

“…Within urology, ERAS has shown improved patient experience, faster recovery, and fewer complications in both children and adults. 10-14…”

mentioning

confidence: 99%

Enhanced Recovery After Surgery for an Uncommon Complex Urological Procedure: The Complete Primary Repair of Bladder Exstrophy

et al. 2023

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Purpose: ERAS (enhanced recovery after surgery) protocols are designed to optimize perioperative care and expedite recovery. Historically, complete primary repair of bladder exstrophy has included postoperative recovery in the intensive care unit and extended length of stay. We hypothesized that instituting ERAS principles would benefit children undergoing complete primary repair of bladder exstrophy, decreasing length of stay. We describe implementation of a complete primary repair of bladder exstrophyeERAS pathway at a single, freestanding children's hospital. Materials and Methods: A multidisciplinary team developed an ERAS pathway for complete primary repair of bladder exstrophy, which launched in June 2020 and included a new surgical approach that divided the lengthy procedure into 2 consecutive operative days. The complete primary repair of bladder exstrophyeERAS pathway was continuously refined, and the final pathway went into effect in May 2021. Post-ERAS patient outcomes were compared with a pre-ERAS historical cohort (2013-2020). Results: A total of 30 historical and 10 post-ERAS patients were included. All post-ERAS patients had immediate extubation (P [ .04) and 90% received early feeding (P < .001). The median intensive care unit and overall length of stay decreased from 2.5 to 1 days (P [ .005) and from 14.5 to 7.5 days (P < .001), respectively. After final pathway implementation, there was no intensive care unit use (n[4). Postoperatively, no ERAS patient required escalation of care, and there was no difference in emergency department visits or readmissions. Conclusions: Applying ERAS principles to complete primary repair of bladder exstrophy was associated with decreased variations in care, improved patient outcomes, and effective resource utilization. Although ERAS has typically been utilized for high-volume procedures, our study highlights that an enhanced recovery pathway is both feasible and adaptable to less common urological surgeries.

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Enhanced Recovery After Surgery (ERAS) for Lower Urinary Tract Reconstruction in Children

Strine

VanderBrink

2022

Curr Treat Options Peds

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Implementation and sustainability of an enhanced recovery pathway in pediatric bladder reconstruction: Flexibility, commitment, teamwork

Cited by 10 publications

References 20 publications

The role of enhanced recovery after surgery (ERAS) in promoting quality improvement and patient safety in pediatric urology

The role of enhanced recovery after surgery (ERAS) in promoting quality improvement and patient safety in pediatric urology

Enhanced Recovery After Surgery for an Uncommon Complex Urological Procedure: The Complete Primary Repair of Bladder Exstrophy

Enhanced Recovery After Surgery (ERAS) for Lower Urinary Tract Reconstruction in Children

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