Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations
Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations
复制标题
DOI：
10.1016/j.clnu.2013.09.014
复制
发表时间：
2013-12-01
影响因子：
6.3
通讯作者：
Patel, Hitendra R. H.
中科院分区：
文献类型：
--
作者：
Cerantola, Yannick;Valerio, Massimo;Patel, Hitendra R. H.
目的：增强术后恢复（ERAS）途径显著减少了结直肠手术后的并发症和住院时间。这种多模式概念可能可以部分应用于重大泌尿外科手术。目标：主要目标是系统地评估ERAS单项和方案应用于膀胱切除术患者的证据。第二个目标是解决一个等级的建议，每个项目的基础上的证据，如果缺乏，从我们的ERAS社会工作group.Evidence收购的共识意见：一个系统的文献综述进行ERAS cysteinase通过搜索EMBASE和Medline。相关文章由两名独立评审员使用GRADE方法选择和质量评估。如果没有具体的研究，以cyclohexane是任何给定的22个项目，作者评估是否结直肠指南可以extruderated.Evidence合成：总体而言，804篇文章从电子数据库中检索。本系统综述纳入了15篇文章，对22个ERAS项目中的7个进行了研究。肠道准备没有改善结果。早期拔除鼻胃管可降低发病率、肠道恢复时间和住院时间。多普勒引导的液体管理允许降低发病率。一个更快的肠道恢复观察与多模式的肠梗阻预防，包括口香糖咀嚼，预防PONV和微创surgery.Conclusions：ERAS尚未广泛实施在泌尿外科和证据的个人干预是有限的或不可用。在其他外科学科的经验鼓励发展一个ERAS协议的cysteine。(C)2013年欧洲临床营养与代谢学会。由爱思唯尔有限公司出版。保留所有权利。
Purpose: Enhanced recovery after surgery (ERAS) pathways have significantly reduced complications and length of hospital stay after colorectal procedures. This multimodal concept could probably be partially applied to major urological surgery.Objectives: The primary objective was to systematically assess the evidence of ERAS single items and protocols applied to cystectomy patients. The secondary objective was to address a grade of recommendation to each item, based on the evidence and, if lacking, on consensus opinion from our ERAS Society working group.Evidence acquisition: A systematic literature review was performed on ERAS for cystectomy by searching EMBASE and Medline. Relevant articles were selected and quality-assessed by two independent reviewers using the GRADE approach. If no study specific to cystectomy was available for any of the 22 given items, the authors evaluated whether colorectal guidelines could be extrapolated.Evidence synthesis: Overall, 804 articles were retrieved from electronic databases. Fifteen articles were included in the present systematic review and 7 of 22 ERAS items were studied. Bowel preparation did not improve outcomes. Early nasogastric tube removal reduced morbidity, bowel recovery time and length of hospital stay. Doppler-guided fluid administration allowed for reduced morbidity. A quicker bowel recovery was observed with a multimodal prevention of ileus, including gum chewing, prevention of PONV and minimally invasive surgery.Conclusions: ERAS has not yet been widely implemented in urology and evidence for individual interventions is limited or unavailable. The experience in other surgical disciplines encourages the development of an ERAS protocol for cystectomy. (C) 2013 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.