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Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and

Kyle O Rove1,2, Andrew C Strine3, Duncan T Wilcox4,2

  • 1Department of Pediatric Urology, Children's Hospital Colorado, Aurora, Colorado, USA kyle.rove@childrenscolorado.org.

BMJ Open
|November 25, 2020
PubMed

Insights

This study evaluates the Enhanced Recovery After Surgery (ERAS) protocol for pediatric lower urinary tract reconstruction. The goal is to reduce complications and improve surgical recovery in young patients undergoing these procedures.

Area of Science:

  • Paediatric Urology
  • Surgical Recovery Protocols
  • Enhanced Recovery After Surgery (ERAS)

Background:

  • Lower urinary tract reconstruction in children is a high-stress procedure with significant complication rates.
  • Existing data suggests Enhanced Recovery After Surgery (ERAS) protocols can reduce complications in paediatric urology.
  • A standardized ERAS protocol is needed for lower urinary tract reconstruction in paediatric and young adult patients.

Purpose of the Study:

  • To develop and assess the feasibility of a multicentre Enhanced Recovery After Surgery (ERAS) protocol for paediatric lower urinary tract reconstruction.
  • To define and measure process, patient-reported, and clinically relevant outcomes.
  • To compare outcomes between ERAS protocol patients and historical controls.

Main Methods:

  • A multicentre, prospective, propensity-matched, case-control study design.
  • Inclusion of paediatric and adolescent/young adult patients (4-25 years) undergoing specific lower urinary tract reconstructions.
  • Pilot phase to verify implementation, followed by propensity matching to historical controls for the main study.
  • Outcome measures include protocol adherence, length of stay, readmissions, reoperations, ER visits, complications, pain, and opioid use.

Main Results:

  • The study is designed to detect a 2-day decrease in mean length of stay.
  • Pilot phase will assess protocol adherence (target ≥70%) and reasons for deviations.
  • Exploratory phase will analyze ERAS protocol adherence and secondary outcomes including length of stay, readmissions, and complications.

Conclusions:

  • This study will provide crucial insights into the feasibility and impact of ERAS protocols in paediatric lower urinary tract reconstruction.
  • Findings will inform best practices and guide future iterations of ERAS implementation in paediatric surgical care.
  • The research aims to improve patient outcomes and reduce healthcare resource utilization.
Abstract

Keywords:
Mitrofanoffbladder augmentationenhanced recovery after surgeryprotocolurinary diversion

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