Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Megan Melnyk, Rowan G. Casey, Peter Black, Anthony J. Koupparis

Abstract


Radical cystectomy with pelvic lymph node dissection remains
the standard treatment for patients with muscle invasive bladder
cancer. Despite improvements in surgical technique, anesthesia
and perioperative care, radical cystectomy is still associated
with greater morbidity and prolonged in-patient stay after surgery
than other urological procedures. Enhanced recovery after surgery
(ERAS) protocols are multimodal perioperative care pathways
designed to achieve early recovery after surgical procedures by
maintaining preoperative organ function and reducing the profound
stress response following surgery. The key elements of ERAS
protocols include preoperative counselling, optimization of nutrition,
standardized analgesic and anesthetic regimens and early
mobilization. Despite the significant body of evidence indicating
that ERAS protocols lead to improved outcomes, they challenge
traditional surgical doctrine, and as a result their implementation
has been slow.
The present article discusses particular aspects of ERAS protocols
which represent fundamental shifts in surgical practice, including
perioperative nutrition, management of postoperative ileus and
the use of mechanical bowel preparation.

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DOI: http://dx.doi.org/10.5489/cuaj.693