Enhanced Recovery After Surgery for an Uncommon Complex Urological Procedure: The Complete Primary Repair of Bladder Exstrophy.
Enhanced Recovery After Surgery for an Uncommon Complex Urological Procedure: The Complete Primary Repair of Bladder Exstrophy.
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罕见复杂泌尿外科手术术后加速康复：膀胱外翻的完全一期修复。
DOI：
10.1097/ju.0000000000003593
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Lee,RichardS
中科院分区：
文献类型：
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作者：
Balthazar,AndreaK;Finkelstein,JuliaB;Williams,Vivian;Lee,Ted;Lajoie,Debra;Logvinenko,Tanya;Kim,Young-Jo;Chacko,Sabeena;Borer,JosephG;Lee,RichardS
目的ERAS(手术后增强恢复)方案旨在优化围手术期护理，加速康复。从历史上看，膀胱外翻的完全初级修复包括在重症监护病房的术后恢复和延长住院时间。我们假设，建立ERAS原则将有利于接受膀胱外翻完全初级修复的儿童，减少住院时间。我们描述了在一家独立的儿童医院实施的膀胱外翻完全一期修复-ERAS路径。材料和方法一个多学科团队开发了一种用于膀胱外翻完全一期修复的ERS路径，该路径于2020年6月推出，其中包括一种新的手术入路，将漫长的过程分成连续两个手术日。膀胱外翻的完全初级修复-ERAS通路不断细化，最终通路于2021年5月生效。将后时代患者的预后与前时代历史队列(2013-2020年)进行比较。结果共纳入30名历史患者和10名后时代患者。所有术后患者均立即拔管(P=.04)，90%接受早期喂养(P<；.001)。重症监护病房的中位数和总住院时间分别从2.5天减少到1天(P=.005)和从14.5天减少到7.5天(P<；.001)。在最终路径实施后，没有使用重症监护病房(n=4)。术后无一例患者需要加强护理，急诊科就诊或再入院的情况也没有差异。结论应用ERAS原则完成膀胱外翻的一期修复与减少护理的差异、改善患者预后和有效的资源利用有关。虽然ERAS通常被用于大容量手术，但我们的研究强调，增强的恢复途径既可行又适用于不太常见的泌尿外科手术。
PurposeERAS (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.Materials and MethodsA 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).ResultsA 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.ConclusionsApplying 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.