Enhanced Recovery After Surgery for an Uncommon Complex Urological Procedure: The Complete Primary Repair of Bladder...

Area of Science:

• Pediatric Urology
• Surgical Outcomes
• Healthcare Management

Background:

• Complete primary repair of bladder exstrophy traditionally involves prolonged intensive care unit (ICU) stays and extended hospitalization.
• Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative care and accelerate patient recovery.
• The application of ERAS to complex pediatric urological procedures like bladder exstrophy repair has not been extensively studied.

Purpose of the Study:

• To evaluate the impact of implementing an ERAS pathway on the length of stay and patient outcomes for children undergoing complete primary repair of bladder exstrophy.
• To determine the feasibility and effectiveness of ERAS principles in a less common, high-complexity urological surgery.
• To reduce variations in care and improve resource utilization for bladder exstrophy repair.

Main Methods:

• Development and implementation of a multidisciplinary ERAS pathway for complete primary repair of bladder exstrophy, including a staged surgical approach over two days.
• Comparison of patient outcomes (length of stay, ICU utilization, feeding tolerance, need for escalated care) between a historical cohort (pre-ERAS) and patients managed under the ERAS pathway.
• Continuous refinement of the ERAS pathway following its initial launch.

Main Results:

• Patients managed with the ERAS pathway demonstrated immediate extubation and significantly earlier feeding initiation compared to the historical cohort.
• Median intensive care unit length of stay decreased from 2.5 to 1 day, and overall length of stay reduced from 14.5 to 7.5 days.
• Post-ERAS implementation, there was no ICU utilization in a subset of patients, no escalation of care required, and no difference in emergency department visits or readmissions.

Conclusions:

• Implementing ERAS principles for complete primary repair of bladder exstrophy significantly decreases length of stay and improves patient outcomes.
• The ERAS pathway led to decreased variations in care and more effective resource utilization.
• This study demonstrates the adaptability and feasibility of ERAS pathways for less common pediatric urological surgeries.