Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
Surgical Programs, Boston Children's Hospital, Boston, Massachusetts.
J Urol. 2023 Oct;210(4):696-703. doi: 10.1097/JU.0000000000003593. Epub 2023 Jun 19.
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 exstrophy-ERAS pathway at a single, freestanding children's hospital.
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 exstrophy-ERAS 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).
A total of 30 historical and 10 post-ERAS patients were included. All post-ERAS patients had immediate extubation ( = .04) and 90% received early feeding ( < .001). The median intensive care unit and overall length of stay decreased from 2.5 to 1 days ( = .005) and from 14.5 to 7.5 days ( < .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.
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.
ERAS（手术后加速康复）方案旨在优化围手术期护理并加速康复。历史上，完全性膀胱外翻初次修复术包括术后在重症监护病房的恢复和延长住院时间。我们假设实施 ERAS 原则将使接受完全性膀胱外翻初次修复术的患儿受益，缩短住院时间。我们描述了在一家独立的儿童医院实施完全性膀胱外翻初次修复术 ERAS 途径的情况。
一个多学科团队为完全性膀胱外翻初次修复术制定了 ERAS 途径，该途径于 2020 年 6 月启动，包括一种新的手术方法，将冗长的手术过程分为连续两天进行。完全性膀胱外翻初次修复术 ERAS 途径不断得到完善，最终途径于 2021 年 5 月生效。比较了 ERAS 后患者的结局与 ERAS 前的历史队列（2013-2020 年）。
共纳入 30 例历史对照患者和 10 例 ERAS 后患者。所有 ERAS 后患者均立即拔管（ =.04），90%的患者早期进食（ <.001）。重症监护病房和总住院时间中位数分别从 2.5 天缩短至 1 天（ =.005）和从 14.5 天缩短至 7.5 天（ <.001）。最终途径实施后，有 4 例患者无需入住重症监护病房。术后，无 ERAS 患者需要增加治疗，急诊就诊和再入院率无差异。
将 ERAS 原则应用于完全性膀胱外翻初次修复术与减少护理差异、改善患者结局和有效利用资源相关。尽管 ERAS 通常用于高容量手术，但我们的研究表明，强化康复途径不仅可行，而且适用于不太常见的泌尿外科手术。
