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Enhanced recovery after urologic surgery: A VA Experience.

Upendra Maddineni

Background: Enhanced recovery after surgery (ERAS) protocols have become standard of care in perioperative management.
Methods: We retrospectively analyzed consecutive patients at our VA institution undergoing urologic surgery, namely nephrectomy and prostatectomy, with ERAS management over a sixmonth timeframe.
Findings: 62 patients underwent prostate (n=32) or kidney surgery (n=30) at our institution between September 2017 and February 2018. Median ERAS length of hospital stay for the prostatectomy group was 1.5 days and 3 days for the nephrectomy group (p=0.001). Intraoperatively, there was a trend towards increased median fluid administration for the ERAS nephrectomy group compared to the ERAS prostatectomy group (2275 vs 1990.5 ml; p=0.05), without a significant increase in estimated blood loss or total operative time. Patients in the ERAS prostate surgery group were out of bed one day sooner compared to patients in the ERAS kidney surgery group (median post op day 1 vs. median post op day 2, p=0.02). Minor complications were similar for both groups (36.7% for the ERAS nephrectomy group compared to 21.9% for the ERAS prostatectomy group; p=0.26), however there was a significant difference in major complications (26.7% for the ERAS nephrectomy group compared to 3.1% for the prostatectomy group; p=0.01). 30- and 90-day readmission rates were similar between the ERAS nephrectomy and ERAS prostatectomy groups (10% vs. 6.3%; p=0.67; and 6.7% vs. 0%; p=0.23). American Society of Anesthesia physical status classification (ASA) score was similar (median ASA 3 vs. 3; p=0.05) for both groups.
Conclusions: Despite ERAS based perioperative management for urologic procedures, there are significant differences in outcomes in this observational comparative study, possibly related to patient and or surgical factors.