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Vol. 45. Issue 2.
Pages 103-115 (March 2021)
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Vol. 45. Issue 2.
Pages 103-115 (March 2021)
Review article
DOI: 10.1016/j.acuroe.2021.01.001
Implementation of ERAS (Enhanced Recovery After Surgery) protocols for radical cystectomy patients: The pathway to standardization. A systematic review
Aplicación de protocolos ERAS (Enhanced Recovery After Surgery) en pacientes cistectomizados: el camino hacia la estandarización. Una revisión sistemática
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R. España-Navarro
Corresponding author
rodrigoespanaurologia@gmail.com

Corresponding author.
, P Rabadán-Márquez, D. Pérez-Argüelles, N Sánchez-Martínez, D Hernández-Alcaraz, E García-Galisteo
Servicio de Urología, Hospital Regional Universitario, Málaga, Spain
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Table 1. Characteristics of the studies.
Table 2. Demographic characteristics.
Table 4. Protocol analysis.
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Abstract
Context

The development of ERAS (Enhanced Recovery After Surgery) protocols in patients undergoing major surgery has brought perioperative benefits in several disciplines. Its main application in urology is focused on patients undergoing radical cystectomy.

Objective

Systematic review of the available literature on ERAS protocols applied to patients undergoing radical cystectomy in terms of perioperative outcomes as well in the analysis of their implementation.

Evidence acquisition

A bibliographic search was conducted in the electronic databases PubMed, Embase, Cochrane and Scopus, using the terms ≪Cystectomy>>, ≪Enhanced Recovery After Surgery>> and ≪Fast-Track>>. Randomized and non-randomized studies that compared the implementation of an ERAS protocol versus a traditional protocol in patients undergoing radical cystectomy were selected.

Evidence synthesis

869 articles were identified; 25 were selected for final analysis: 22 non-randomized and 3 randomized studies. No differences were observed in terms of demographic characteristics between studies. Statistically significant differences were identified in favor of the ERAS protocol: length of hospital stay, major complication rate, time to first ambulation and return of bowel function. In the analysis of protocols, a high variability was detected in the number of items and in the implementation method.

Conclusions

The multidisciplinary nature and the number of items of the ERAS protocols imply a high heterogeneity in their implementation. Further randomized studies, standardized reporting and analyzing results, as well as a systematic analysis of subsequent adherence are required to increase comparability between groups.

Keywords:
ERAS
Cystectomy
Recovery
Review
Resumen
Contexto

El desarrollo de protocolos ERAS (Enhanced Recovery After Surgery) en pacientes sometidos a cirugía mayor ha aportado beneficios perioperatorios en diversas disciplinas. En urología, su principal aplicación se centra en pacientes sometidos a cistectomía radical.

Objetivo

Revisión sistemática de la literatura disponible de protocolos ERAS aplicados a pacientes intervenidos de cistectomía radical, tanto a nivel de resultados perioperatorios como en el análisis de su implementación.

Adquisición de la evidencia

Se realizó búsqueda bibliográfica en base de datos electrónicas Pubmed, Embase, Cochrane y Scopus, utilizando los términos ≪Cystectomy≫, ≪Enhanced Recovery After Surgery≫ y ≪Fast-Track≫. Se seleccionaron estudios aleatorizados y no aleatorizados que comparasen la implementación de un protocolo ERAS en pacientes sometidos a cistectomía radical frente a un protocolo tradicional.

Síntesis de la evidencia

Se identificaron 869 artículos; 25 fueron seleccionados para el análisis final: 22 estudios no aleatorizados y 3 aleatorizados. No se detectaron diferencias en cuanto a características demográficas entre los distintos estudios. Se identificaron diferencias estadísticamente significativas a favor del protocolo ERAS en tiempo de estancia hospitalaria, tasa de complicaciones mayores, tiempo a primera deambulación y recuperación intestinal. En el análisis de protocolos se detectó una alta variabilidad, tanto en número de ítems como en método de implementación.

Conclusiones

El carácter multidisciplinar y el número de ítems de los protocolos ERAS conlleva una alta heterogeneidad en su implementación. Se requieren más estudios aleatorizados, estandarización a la hora de reportar y analizar resultados, así como un análisis sistemático de la adherencia posterior para aumentar la comparabilidad entre grupos.

Palabras clave:
ERAS
Cistectomía
Recuperación
Revisión

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