Abstract：
BACKGROUND: Consensus for Enhanced Recovery After Surgery (ERAS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of ERAS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the ERAS protocol in children.
METHODS: A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed.
RESULTS: Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies.
CONCLUSIONS: There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.
METHODS: A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed.
RESULTS: Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies.
CONCLUSIONS: There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.
摘要：
背景：在新生儿肠道手术中已经达成了儿科手术后增强恢复（ERAS）的共识，然而，它并没有广泛用于儿科泌尿科。我们调查了ERAS指南在儿科泌尿外科的应用，并根据支持儿童ERAS方案的现有证据水平确定其效果。
方法：进行了系统的文献综述，包括一系列提供采用小儿泌尿外科快速康复方案的文献综述。主要结局指标是研究特征，坚持19个ERAS项目，并发症发生率和住院时间。按手术类型（尿道下裂与大手术）进行亚组分析。
结果：包括来自1272例外科儿科病例的9个系列数据。67.3%的报告采用了增强的回收途径。两个系列包括接受尿道下裂修复的患者，ERAS项目报告不足。包括接受重大手术的儿童在内的研究提到了15个ERAS项目的中位数，但应用的中位数为11个项目。中位依从率为88.9%(范围50-100)。在最近发表的研究中，更多的ERAS指南项目被报道（应用或提及）。
结论：在泌尿外科手术中，特别是在尿道下裂修复中，ERAS指南的报告和使用有限；而在儿童大手术中，坚持和遵守率差异很大。在最近的系列中，提到和应用的ERAS项目有所增加。需要未来的研究来确定障碍并克服障碍，以便充分利用ERAS途径并从中受益。
方法：进行了系统的文献综述，包括一系列提供采用小儿泌尿外科快速康复方案的文献综述。主要结局指标是研究特征，坚持19个ERAS项目，并发症发生率和住院时间。按手术类型（尿道下裂与大手术）进行亚组分析。
结果：包括来自1272例外科儿科病例的9个系列数据。67.3%的报告采用了增强的回收途径。两个系列包括接受尿道下裂修复的患者，ERAS项目报告不足。包括接受重大手术的儿童在内的研究提到了15个ERAS项目的中位数，但应用的中位数为11个项目。中位依从率为88.9%(范围50-100)。在最近发表的研究中，更多的ERAS指南项目被报道（应用或提及）。
结论：在泌尿外科手术中，特别是在尿道下裂修复中，ERAS指南的报告和使用有限；而在儿童大手术中，坚持和遵守率差异很大。在最近的系列中，提到和应用的ERAS项目有所增加。需要未来的研究来确定障碍并克服障碍，以便充分利用ERAS途径并从中受益。
