April 15, 2013Canadian Urological Association Journal335 citationsOpen Access

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Q: What is the clinical evidence from this study?

Study design: Review. Population: Muscle invasive bladder cancer undergoing radical cystectomy. Intervention: Enhanced recovery after surgery (ERAS) protocols vs. Traditional surgical care.

MMMegan MelnykUniversity of British Columbia RCRowan G. CaseyUniversity of Essex PBPeter BlackLoma Linda University

Key Result

Enhanced recovery after surgery (ERAS) protocols challenge traditional surgical doctrine but lead to improved outcomes, including reduced hospital stay and complications, for patients undergoing radical cystectomy.

Structured PICO

Do Enhanced recovery after surgery (ERAS) protocols improve recovery in patients with muscle invasive bladder cancer undergoing radical cystectomy?

Population

Patients with muscle invasive bladder cancer undergoing radical cystectomy

Intervention

Enhanced recovery after surgery (ERAS) protocols

Comparator

Traditional surgical doctrine

Outcome

Early recovery after surgical procedures

ERAS protocols offer improved outcomes for radical cystectomy patients but require fundamental shifts in traditional surgical practice.

Limitations

Implementation of ERAS protocols has been slow due to challenges to traditional surgical doctrine.
Requires significant multidisciplinary team coordination and overcoming traditional attitudes towards perioperative care.

Abstract

Radical cystectomy with pelvic lymph node dissection remainsthe standard treatment for patients with muscle invasive bladdercancer. Despite improvements in surgical technique, anesthesiaand perioperative care, radical cystectomy is still associatedwith greater morbidity and prolonged in-patient stay after surgerythan other urological procedures. Enhanced recovery after surgery(ERAS) protocols are multimodal perioperative care pathwaysdesigned to achieve early recovery after surgical procedures bymaintaining preoperative organ function and reducing the profoundstress response following surgery. The key elements of ERASprotocols include preoperative counselling, optimization of nutrition,standardized analgesic and anesthetic regimens and earlymobilization. Despite the significant body of evidence indicatingthat ERAS protocols lead to improved outcomes, they challengetraditional surgical doctrine, and as a result their implementationhas been slow.The present article discusses particular aspects of ERAS protocolswhich represent fundamental shifts in surgical practice, includingperioperative nutrition, management of postoperative ileus andthe use of mechanical bowel preparation.

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