Department of Urology, Pediatric Urology and Urological Oncology, St. Antonius Hospital Gronau, Gronau, Germany.
Department of Urology, Martini-Klinik, University Clinic Hamburg-Eppendorf, Hamburg, Germany.
J Robot Surg. 2022 Apr;16(2):415-419. doi: 10.1007/s11701-021-01260-1. Epub 2021 May 29.
Several benefits have been reported after applying the principles of enhanced recovery after surgery (ERAS) into the perioperative care of patients undergoing robot-assisted radical prostatectomy (RARP). Nevertheless, there are still barriers. We aimed to identify the key areas by systematically surveying urology departments in Germany and Austria. A 27-question survey on the adoption of ERAS principles for the perioperative care of RARP patients was designed, in compliance with the guidelines on good practice in conducting and reporting of survey research. After positive testing for face and content validity, the survey was distributed via postal mail to 82 departments performing RARP. In total, 39 departments responded to our survey (response rate 48%). The ERAS adoption rates ranged from 21 to 97%, with nine ERAS principles being widely adopted (72-92% of the departments). The lowest adoption rates and, subsequently, the largest potential for optimization were detected for the preoperative nutrition counselling (21%), preoperative pelvic floor physiotherapy (54%), postoperative early initiation of nutrition (44%) and postoperative patient audit for further quality improvement (36%). High-volume centers performed more frequently a perioperative nutrition counselling (8/27; 30%) than low-volume centers (0/12; 0%; p = 0.036). The implementation of the ERAS principles into the perioperative care algorithm were medium-to-high, yet not optimal. Our real-world data assessment revealed four key areas showing low adoption rates (nutrition counselling, preoperative pelvic floor physiotherapy, early initiation of nutrition and patient audit), implying a great potential for further optimization.
在将术后加速康复（ERAS）原则应用于机器人辅助根治性前列腺切除术（RARP）患者的围手术期护理后，已经报告了一些益处。然而，仍然存在障碍。我们旨在通过系统地调查德国和奥地利的泌尿科部门来确定关键领域。根据关于调查研究的良好实践的指南，设计了一项关于采用 ERAS 原则来进行 RARP 患者围手术期护理的 27 个问题的调查。在经过正面的表面有效性和内容有效性测试后，该调查通过邮寄方式分发给 82 个进行 RARP 的部门。共有 39 个部门对我们的调查做出了回应（回应率为 48%）。ERAS 的采用率从 21%到 97%不等，有九个 ERAS 原则得到了广泛采用（72%-92%的部门）。术前营养咨询（21%）、术前盆底物理治疗（54%）、术后早期营养启动（44%）和术后患者审核以进一步提高质量（36%）的采用率最低，因此优化的潜力最大。高容量中心比低容量中心更频繁地进行围手术期营养咨询（8/27；30%）而不是低容量中心（0/12；0%；p=0.036）。ERAS 原则在围手术期护理算法中的实施是中等至高的，但不是最佳的。我们的真实数据评估显示，有四个关键领域的采用率较低（营养咨询、术前盆底物理治疗、早期营养启动和患者审核），这意味着进一步优化的潜力很大。
