A Review of Enhanced Recovery Protocols in Pelvic Surgery
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RECONSTRUCTED BLADDER FUNCTION & DYSFUNCTION (M KAUFMAN, SECTION EDITOR)
A Review of Enhanced Recovery Protocols in Pelvic Surgery Lauren Pace 1 & Rena Malik 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To evaluate recent literature relevant to the review and appraisal of enhanced recovery protocol after pelvic surgery. Recent Findings Several protocols have recently been implemented and published that utilize aspects of guidelines published by the Enhanced Recovery After Surgery (ERAS) Society. These studies have added to the body of literature confirming the efficacy of enhanced recovery protocols. Summary While evidence exists and is commonly cited for individual interventions, in recent years, there has been an increase in the study of novel protocols for enhanced recovery. These studies show that in many cases protocol implementation can lead to decreased length of stay and improved patient outcomes, among other endpoints. Keywords Enhanced recovery protocols . Enhanced recovery after surgery . Pelvic surgery . Cystectomy . Gynecology/oncology surgery . Colorectal surgery
Introduction Enhanced Recovery After Surgery (ERAS) protocols utilize evidence-based methods to optimize pre-, intra-, and postoperative care. Since the advent of fast-track protocols in the 1990s and the development of ERAS in 2001, use has become increasingly popular and shown to result in improved clinical outcomes and decreased cost [1]. Despite proven benefits of ERAS, introduction and adoption of protocols across disciplines has been slow. In 2010, the ERAS study group formed the Enhanced Recovery After Surgery Society for Perioperative Care (ERAS Society) with the mission of continued research, education, and implementation surrounding these protocols [2]. The first ERAS guidelines were developed for perioperative optimization of colorectal surgery [3]. Since that time, This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction * Rena Malik [email protected] Lauren Pace [email protected] 1
Division of Urology, University of Maryland School of Medicine, Baltimore, MD, USA
additional ERAS protocols have been developed to encompass multiple modes of pelvic surgery: radical cystectomy, gynecology/oncology, intra-abdominal colorectal, and rectal/ pelvic bowel resection surgery [4–8]. An additional set of protocols for implementation of a urogynecology-specific ERAS pathway was also proposed and shared at the Society of Gynecologic Surgeons Annual Scientific Meeting in March 2018 [9]. Common interventions included in ERAS protocols address preoperative patient screening, preoperative patient education, preoperative fasting and nutrition, preoperative bowel preparation, early initiation of oral intake, early postoperative mobilization, use of drains and catheters, facilitation of perioperative volume and temperature control, and multimodal and opioid-sparing analgesia [10, 11]. Given the variety and number of potential interventio
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