Pathways for Urologic Surgery Potentially Beneficial, Though More Research is Needed

An overview of enhanced recover after surgery (ERAS) pathways has identified some of the key benefits and needs for future research of the programs for patients who receive urological surgery. 

ERAS programs are multidisciplinary, multi-element pathways designed with the intention of improving perioperative management. Studies have shown that use of ERAS programs can reduce postoperative complications by 50%, reduce length of stay by 30%, and decrease readmission rates. Still, some institutions have faced considerable cultural and bureaucratic barriers that have hindered the inclusion of ERAS pathways in many specialty fields, including urology. 

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Authors led by Raed A Azhar, King Abdulaziz University (Jeddah, Saudi Arabia), conducted a systematic literature review of original articles published within the last 5 years using the key words “urology,” “urologic surgery,” and “cystectomy” to analyze any use of ERAS programs. Their research was published in European Urology. 

Electronic search yielded 956 potential urological articles, though only 18 were selected as eligible for the study. From their literature search, researchers were able to identify a number of pre, intra, and postoperative procedures with a proven evidence base for improving the experiences of patients receiving urologic surgery. Examples of some of the methods included pre-anesthetic medications, prophylaxis against venous thromboembolism, perioperative fluid management, urinary drainage, early postoperative mobilization, and the use of postoperative laxatives. 

Researchers also found that ERAS programs were associated with a shorter length of stay following surgery, lower morbidity, and higher physical and emotional quality of life scores. Also, while few studies evaluated the cost effectiveness of EARS programs, one meta-analysis of an ERAS for colorectal cancer found that patients saved an average of $2000 while on the program. Likewise, no significant difference in readmission rate was found between patients treated on ERAS pathways and those on standard care, indicating that the programs appeared to be both efficacious and cost effective.

Data from multiple studies also showed that the rate of adverse outcomes was directly related to ERAS adherence, revealing a need for institutions to develop methods that facilitate staff buy-in and encourage use of the systems when they are implemented.

However, despite the data they were able to extract from their review, researchers stated that the main barrier to more widespread use of ERAS programs is a lack of sufficient evidence. The few studies that have been conducted with the direct intention of determining ERAS usefulness in urology have been few and relatively small scale. 

Therefore, while a comprehensive review of ERAS programs for urologic surgery did reveal some potential benefits for improving hospital efficiency and quality of care, researchers concluded that larger prospective studies would be needed to demonstrate the definitive value of ERAS programs for patients and hospitals.—Sean McGuire


Azhar RA, Bochner B, Catto J, et al. Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs. [Published online March 9, 2016]. Eur Urol. 2016. doi: 10.1016/j.eururo.2016.02.051.