Related Experiment Video
Updated: Jun 23, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Application of the ERAS guidelines in pediatric urological surgery: a systematic review
Judith Stangl-Kremser1, Laura Olivera2,3, Sofia Giudici2
1Department of Urology, Weill Cornell Medicine, New York, NY, USA.
Insights
Enhanced Recovery After Surgery (ERAS) guidelines are underutilized in pediatric urology, especially for hypospadias repair. While major pediatric urologic surgeries show varied adherence, recent studies indicate increased ERAS item application.
Area of Science:
- Pediatric Surgery
- Urology
- Evidence-Based Medicine
Background:
- Enhanced Recovery After Surgery (ERAS) protocols are established in neonatal intestinal surgery but not widely adopted in pediatric urology.
- Limited evidence exists on the application and impact of ERAS guidelines in pediatric urologic procedures.
Purpose of the Study:
- To investigate the current application of ERAS guidelines in pediatric urology.
- To assess the evidence supporting ERAS protocols in pediatric urologic surgery.
- To determine adherence and complication rates associated with ERAS implementation.
Main Methods:
- Systematic literature review of studies reporting fast-track recovery protocols in pediatric urology.
- Analysis of study characteristics, adherence to 19 ERAS items, complication rates, and length of hospital stay.
- Sub-group analysis comparing hypospadias repair with major pediatric urologic surgery.
Main Results:
- Nine series (1272 pediatric cases) were included; 67.3% utilized an enhanced recovery pathway.
- ERAS item reporting was insufficient for hypospadias repair studies.
- Major surgery studies reported a median of 11 out of 15 ERAS items, with a median compliance rate of 88.9%.
- More recent studies showed increased reporting and application of ERAS items.
Conclusions:
- ERAS guidelines are underreported and underutilized in pediatric urologic surgery, particularly for hypospadias repair.
- Adherence and compliance with ERAS protocols vary significantly in major pediatric urologic surgeries.
- Further research is required to identify and overcome barriers to full ERAS pathway adoption in pediatric urology.
Introduction:
Consensus for Enhanced Recovery After Surgery (ERAS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of ERAS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the ERAS protocol in children.
Evidence Acquisition:
A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed.
Evidence Synthesis:
Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies.
Conclusions:
There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.
