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Obstacles and sustainability of enhanced recovery after surgery in pediatric laparoscopic pyeloplasty
Wenliang Zhu1, Huajian Lai2, Ziqin He1
1Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Insights
Implementing Enhanced Recovery After Surgery (ERAS) in pediatric Laparoscopic Pyeloplasty (LP) significantly reduced hospital stays and improved patient recovery times. This approach is feasible and sustainable for UPJO patients, with compliance enhancing outcomes.
Area of Science:
- Pediatric Surgery
- Urology
- Enhanced Recovery After Surgery (ERAS) Protocols
Background:
- Previous studies on Enhanced Recovery After Surgery (ERAS) in pediatric Laparoscopic Pyeloplasty (LP) lacked robust control groups and detailed implementation challenges.
- Ureteropelvic junction obstruction (UPJO) is a common condition in pediatric urology requiring surgical intervention.
Purpose of the Study:
- To detail the obstacles and lessons learned during the implementation of ERAS in pediatric patients undergoing LP for UPJO.
- To evaluate the impact of ERAS on clinical outcomes and recovery parameters in this patient population.
Main Methods:
- A retrospective analysis was conducted comparing clinical data from patients before (BI) and after (AI) ERAS protocol implementation for LP in UPJO.
- The ERAS protocol encompassed preoperative, intraoperative, and postoperative management strategies.
Main Results:
- The AI group demonstrated significantly earlier return to normal diet, ambulation, and bowel function compared to the BI group.
- Patients in the AI group experienced a shorter postoperative hospital stay (1.91 days vs. 6.00 days) and required less additional analgesia.
- No increase in complications or readmission rates was observed in the AI group, and ERAS protocol compliance correlated negatively with postoperative hospital stay length.
Conclusions:
- ERAS implementation in pediatric LP for UPJO is feasible, sustainable, and improves recovery metrics.
- Key barriers include uncertain surgery start times, lack of participant knowledge, and insufficient anesthesiologist support.
- Improving ERAS compliance through better surgical scheduling, preoperative education, and team communication can further enhance outcomes.
Objectives:
Previous studies on Enhanced Recovery After Surgery (ERAS) in pediatric Laparoscopic Pyeloplasty (LP) lacked clear control cases and discussed the obstacles in the implementation process. This article details the obstacles and lessons learned during the implementation of ERAS in patients with ureteropelvic junction obstruction (UPJO).
Methods:
An ERAS protocol was implemented in the UPJO population undergoing LP, which included preoperative, intraoperative, and postoperative management. The clinical data of ERAS program Before Implementation (BI) and After Implementation (AI) were collected and analyzed retrospectively.
Results:
A total of 107 patients (BI 46, AI 61) were enrolled. Compared with the BI group, the AI group had an earlier normal diet (19.83 h vs. 9.53 h, p < 0.001), ambulation (39.10 h vs. 12.70 h, p < 0.001), resumption of defecation (89.88 h vs. 27.90 h, p < 0.001), less need for additional analgesia (19.5% vs. 1.6%, p = 0.002) and shorter postoperative hospital stay (POS) (6.00 d vs. 1.91 d, p < 0.001) without increasing complications and readmission rates. Patients in the AI group had a median protocol score of 17 (IQR 16-18), and the compliance rate of the ERAS protocol was negatively correlated with the length of POS (R 2 = 0.69, p < 0.001).
Conclusions:
The application of ERAS in pediatric LP is feasible and sustainable, with the potential for even greater impact as compliance improves. Common barriers were uncertain start time of surgery, lack of knowledge of ERAS among pathway participants, and support from anesthesiologists. Pre-determining the start time of surgery, strengthening preoperative education and positive communication among team members can help to promote the full implementation of ERAS program.
