Enhanced recovery after surgery (ERAS) pathway optimizes outcomes and costs for minimally invasive radical prostatectomy

Ying Xu, Ao Liu, Lu Chen, Hai Huang, Yi Gao, Chuanjie Zhang, Yang Xu, Da Huang, Danfeng Xu, Min Zhang, Ying Xu, Ao Liu, Lu Chen, Hai Huang, Yi Gao, Chuanjie Zhang, Yang Xu, Da Huang, Danfeng Xu, Min Zhang

Abstract

Objective: To evaluate the impact of an enhanced recovery after surgery (ERAS) pathway on patients undergoing minimally invasive radical prostatectomy at a single institute.

Methods: In this retrospective study, 301 patients who underwent laparoscopic or robot-assisted laparoscopic radical prostatectomy from May 2014 to September 2018 were consecutively recruited. Before April 2017, the patients were treated with conventional care; all patients were treated with the ERAS pathway thereafter. The primary outcome was the postoperative length of hospital stay (LOS). The secondary outcomes were hospitalization costs and postoperative complications.

Results: In total, 138 patients were treated with the ERAS pathway, and the remaining patients underwent conventional care. The postoperative LOS was significantly shorter in the ERAS group than in the conventional group (median, 6 vs. 8 days). The hospitalization costs were also significantly lower in the ERAS group ($4086 vs. $5530). Ten (6.1%) patients in the ERAS group and 17 (12.3%) patients in the conventional group developed postoperative complications. The multivariable analysis showed that ERAS care was a significant independent predictive factor for a shortened LOS and reduced hospitalization costs.

Conclusions: The ERAS pathway was associated with a shortened LOS and reduced hospitalization costs for patients undergoing minimally invasive radical prostatectomy.

Keywords: Enhanced recovery after surgery; hospitalization costs; laparoscopic radical prostatectomy; length of hospital stay; minimally invasive surgery; perioperative care.

References

    1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394–424. DOI: 10.3322/caac.21492.
    1. Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 2017; 71: 618–629. DOI: 10.1016/j.eururo.2016.08.003.
    1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg 2017; 152: 292–298. DOI: 10.1001/jamasurg.2016.4952.
    1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997; 78: 606–617.
    1. Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 1999; 86: 227–230. DOI: 10.1046/j.1365-2168.1999.01023.x.
    1. Visioni A, Shah R, Gabriel E, et al. Enhanced recovery after surgery for noncolorectal surgery?: A systematic review and meta-analysis of major abdominal surgery. Ann Surg 2018; 267: 57–65. DOI: 10.1097/sla.0000000000002267.
    1. Pang KH, Groves R, Venugopal S, et al. Prospective implementation of enhanced recovery after surgery protocols to radical cystectomy. Eur Urol 2018; 73: 363–371. DOI: 10.1016/j.eururo.2017.07.031.
    1. Kennedy RH, Francis EA, Wharton R, et al. Multicenter randomized controlled trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme: EnROL. J Clin Oncol 2014; 32: 1804–1811. DOI: 10.1200/jco.2013.54.3694.
    1. Liu VX, Rosas E, Hwang J, et al. Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg 2017; 152: e171032. DOI: 10.1001/jamasurg.2017.1032.
    1. ERAS Compliance Group . The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 2015; 261: 1153–1159. DOI: 10.1097/sla.0000000000001029.
    1. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Clin Nutr 2012; 31: 801–816. DOI: 10.1016/j.clnu.2012.08.012.
    1. Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2011; 28: 556–569. DOI: 10.1097/EJA.0b013e3283495ba1.
    1. Hashad MM, Atta M, Elabbady A, et al. Safety of no bowel preparation before ileal urinary diversion. BJU Int 2012; 110: E1109–E1113. DOI: 10.1111/j.1464-410X.2012.11415.x.
    1. Madrid E, Urrutia G, Roque i Figuls M, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database Syst Rev 2016; 4: Cd009016. DOI: 10.1002/14651858.CD009016.pub2.
    1. Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016; 388: 1057–1066. DOI: 10.1016/s0140-6736(16)30592-x.
    1. Nimmo SM, Foo ITH, Paterson HM. Enhanced recovery after surgery: pain management. J Surg Oncol 2017; 116: 583–591. DOI: 10.1002/jso.24814.
    1. Cerantola Y, Valerio M, Persson B, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS(®)) society recommendations. Clin Nutr 2013; 32: 879–887. DOI: 10.1016/j.clnu.2013.09.014.
    1. Pillai P, McEleavy I, Gaughan M, et al. A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy. J Urol 2011; 186: 2201–2206. DOI: 10.1016/j.juro.2011.07.093.
    1. Azhar RA, Bochner B, Catto J, et al. Enhanced recovery after urological surgery: a contemporary systematic review of outcomes, key elements, and research needs. Eur Urol 2016; 70: 176–187. DOI: 10.1016/j.eururo.2016.02.051.
    1. Gralla O, Haas F, Knoll N, et al. Fast-track surgery in laparoscopic radical prostatectomy: basic principles. World J Urol 2007; 25: 185–191. DOI: 10.1007/s00345-006-0139-2.
    1. Huang Z, Yi L, Zhong Z, et al. Comparison of fast-track versus conventional surgery protocol for patients undergoing robot-assisted laparoscopic radical prostatectomy: a Chinese experience. Sci Rep 2018; 8: 8017. DOI: 10.1038/s41598-018-26372-x.
    1. Spanjersberg WR, van Sambeeck JD, Bremers A, et al. Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 2015; 29: 3443–3453. DOI: 10.1007/s00464-015-4148-3.
    1. Pache B, Hubner M, Jurt J, et al. Minimally invasive surgery and enhanced recovery after surgery: the ideal combination? J Surg Oncol 2017; 116: 613–616. DOI: 10.1002/jso.24787.
    1. Esteban F, Cerdan FJ, Garcia-Alonso M, et al. A multicentre comparison of a fast track or conventional postoperative protocol following laparoscopic or open elective surgery for colorectal cancer surgery. Colorectal Dis 2014; 16: 134–140. DOI: 10.1111/codi.12472.
    1. Goulet D, Danilack V, Matteson KA. Enhanced recovery pathways for improving outcomes after minimally invasive gynecologic oncology surgery. Obstet Gynecol 2017; 129: 207. DOI: 10.1097/aog.0000000000001833.
    1. Yost MT, Jolissaint JS, Fields AC, et al. Enhanced recovery pathways for minimally invasive esophageal surgery. J Laparoendosc Adv Surg Tech A 2018; 28: 496–500. DOI: 10.1089/lap.2018.0073.
    1. Suda K, Nakauchi M, Inaba K, et al. Minimally invasive surgery for upper gastrointestinal cancer: our experience and review of the literature. World J Gastroenterol 2016; 22: 4626–4637. DOI: 10.3748/wjg.v22.i19.4626.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅