UPMC Children’s Pediatric Urology Division Contributes to Multicenter Study on Enhanced Recovery After Surgery for Pediatric Patients

The Journal of Pediatric Urology published a new study in December 2023 on the feasibility of implementing enhanced recovery after surgery (ERAS) protocols in pediatric urology.

The study was conducted by the multicenter PURSUE Study Group, of which the UPMC Children's Division of Pediatric Urology is a member. Leading the study at the UPMC Children’s site was assistant professor of Urology and division clinical director Rajeev Chaudhry, MD.

The study aimed to assess the feasibility and challenges of introducing ERAS protocols in pediatric patients undergoing complex lower urinary tract reconstruction. ERAS, an evidence-based concept widely applied in adult surgical disciplines, focuses on improving patient outcomes through an optimized perioperative care pathway. However, while ERAS protocols have achieved impressive benefits with adult patients, it has had limited exploration and adoption in pediatric surgical programs.

For this prospective study, the eight participating centers were instructed to adopt an ERAS protocol utilizing a multidisciplinary team approach. Endpoints of the study included enrollment and 90-day follow-up of patients, identification of implementation barriers, and adherence to the ERAS protocol.

Study Findings and Implication for Future Clinical Practice

A total of 40 patients were enrolled from the eight centers, with the median age at surgery being 10.3 years. Diagnoses among patients included a high percentage of myelomeningocele (65%) and ventriculoperitoneal shunts (33%). The surgical procedures performed varied, with bladder augmentation (70%), Mitrofanoff appendicovesicostomy (52%), Monti ileovesicostomy (15%), and antegrade continence enema channel (38%) among the most prevalent.

The study identified challenges such as difficulty in maintaining compliance with the ERAS pathway and constraints related to resources.

However, the findings from the study did show that ERAS protocols can be effectively implemented in pediatric urology for complex lower urinary tract reconstructions

“While ERAS has pretty thoroughly demonstrated its benefits in adult patients over that last decade or more – including in urology, its adoption for surgery in children has been slow,” says Dr. Chaudhry. “As we discuss in the paper, ERAS can be successfully implemented in pediatric urology, but it has to be accomplished through a multidisciplinary team approach, one that takes into account the dynamics of the surgeries and patient populations involved, and with an attention to continual quality improvement and monitoring of efficacy and adherence.”

Read the entire study and its findings using the reference link below.

Reference

Strine AC, Chu DI, Brockel MA, et al; PURSUE Study Group. Feasibility of Enhanced Recovery After Surgery (ERAS) Implementation in Pediatric Urology: Pilot-Phase Outcomes of a Prospective, Multicenter Study. J Pediatr Urol. 2023 Dec 30: S1477-5131. Online ahead of print.