背景:加速术后恢复(ERAS)是多模式途径的组合,以改善手术结果。ERAS协会已发布了根治性膀胱切除术的建议,但缺乏肾脏切除术(Ne)和根治性前列腺切除术(RP)等泌尿外科手术的证据。我们研究的目的是评估我们学术机构对NeadRP实施增强恢复协议的影响。
方法:我们进行了回顾性研究,单心,比较分析,对接受机器人辅助根治性前列腺切除术或肾切除术(部分或全部)治疗癌症的患者实施强化恢复方案前后。主要终点是平均住院时间(LOS)。次要终点包括30天再入院,术后并发症,90天存活,和6个月时的肿瘤学结果。
结果:我们纳入了1月之间的264例患者,2019年12月,2020年。分别按手术类型进行统计分析。ERP方案中包含的患者的LOS平均降低1,3天IC95%[-2.50;-0.08],p<0.001对于肾切除术和2.2天IC95%[-3.72;-0.62]p<0.001对于前列腺切除术,与非ERP患者相比。没有更多的重新录取,死亡或肿瘤复发。
结论:根据我们的经验,肿瘤肾切除术和前列腺切除术的ERP减少了住院时间,不增加术后并发症和再入院。
BACKGROUND: Enhanced recovery after surgery (ERAS) is a combination of multimodal pathways to improve surgical outcomes. Recommendations for radical cystectomy have been published by the ERAS society for the cystectomy but a lack of evidence is observed for urological procedures such as
nephrectomy (Ne) and radical prostatectomy (RP). The aim of our study was to evaluate the impact of enhanced recovery protocol implementation for Ne ad RP at our academic institution.
METHODS: We performed a retrospective, monocentric, comparative analysis, pre and post implementation of an enhanced recovery protocol for patients undergoing robotic-assisted radical prostatectomy or
nephrectomy (partial or total) for cancer. The primary endpoint was the mean length of stay (LOS). Secondary endpoints included 30-days readmission, postoperative complications, 90 days survival, and oncologic outcome at 6 months.
RESULTS: We included 264 patients between January, 2019, and December, 2020. Statistical analysis was performed separately by type of surgery. The LOS of patients included in the ERP protocol was decreased on average by 1,3 days IC95% [ -2.50; -0.08], p<0.001 for nephrectomies and by 2.2 days IC95% [-3.72; -0.62] p<0.001 for prostatectomies, compared to non-ERP patients. There were no more re-admisson, death or oncologic recurrence.
CONCLUSIONS: In our experience, ERP for oncological
nephrectomy and prostatectomy reduced the length of stay, without increasing postoperative complications and readmission.