Nathan A Brooks1, Andrea Kokorovic1, John S McGrath2, Wassim Kassouf3, Justin W Collins4, Peter C Black5, James Douglas6, Hooman Djaladat7, Siamak Daneshmand7, James W F Catto8, Ashish M Kamat1, Stephen B Williams9. 1. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 2. Department of Urology, Royal Devon and Exeter NHS Trust, Exeter, UK. 3. Department of Urology, McGill University Health Center, McGill, Montreal, QC, Canada. 4. Department of Urology, University College London Hospital, London, UK. 5. Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada. 6. Department of Urology, University Hospital of Southampton, Hampshire, UK. 7. USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. 8. Academic Urology Unit, University of Sheffield, Sheffield, UK. 9. Division of Urology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA. stbwilli@utmb.edu.
Abstract
PURPOSE: Enhanced recovery after surgery (ERAS) protocols have been implemented across a variety of disciplines to improve outcomes. Herein we describe the impact of ERAS on quality of life (QOL) and cost for patients undergoing urologic oncology surgery. METHODS: A systematic literature search using the MEDLINE, Scopus, Clinictrials.gov, and Cochrane Review databases for studies published between 1946 and 2020 was conducted. Articles were reviewed and assigned a risk of bias by two authors and were included if they addressed ERAS and either QOL or cost-effectiveness for patients undergoing urologic oncology surgery. RESULTS: The literature search yielded a total of 682 studies after removing duplicates, of which 10 (1.5%) were included in the review. Nine articles addressed radical cystectomy, while one addressed ERAS and QOL for laparoscopic nephrectomy. Six publications assessed the impact of ERAS on QOL domains. Questionnaires used for assessment of QOL varied across studies, and timing of administration was heterogeneous. Overall, ERAS improved patient QOL during early phases of recovery within the realms of bowel function, physical/social/cognitive functioning, sleep and pain control. Costs were assessed in 4 retrospective studies including 3 conducted in the United States and one from China all addressing radical cystectomy. Studies demonstrated either decreased costs associated with ERAS as a result of decreased length of stay or no change in cost based on ERAS implementation. CONCLUSION: While limited studies are published on the subject, ERAS implementation for radical cystectomy and laparoscopic nephrectomy improved patient-reported QOL during early phases of recovery. For radical cystectomy, there was a decreased or neutral overall financial cost associated with ERAS. Further studies assessing QOL and cost-effectiveness over the entire global period of care in a variety of urologic oncology surgeries are warranted.
PURPOSE: Enhanced recovery after surgery (ERAS) protocols have been implemented across a variety of disciplines to improve outcomes. Herein we describe the impact of ERAS on quality of life (QOL) and cost for patients undergoing urologic oncology surgery. METHODS: A systematic literature search using the MEDLINE, Scopus, Clinictrials.gov, and Cochrane Review databases for studies published between 1946 and 2020 was conducted. Articles were reviewed and assigned a risk of bias by two authors and were included if they addressed ERAS and either QOL or cost-effectiveness for patients undergoing urologic oncology surgery. RESULTS: The literature search yielded a total of 682 studies after removing duplicates, of which 10 (1.5%) were included in the review. Nine articles addressed radical cystectomy, while one addressed ERAS and QOL for laparoscopic nephrectomy. Six publications assessed the impact of ERAS on QOL domains. Questionnaires used for assessment of QOL varied across studies, and timing of administration was heterogeneous. Overall, ERAS improved patient QOL during early phases of recovery within the realms of bowel function, physical/social/cognitive functioning, sleep and pain control. Costs were assessed in 4 retrospective studies including 3 conducted in the United States and one from China all addressing radical cystectomy. Studies demonstrated either decreased costs associated with ERAS as a result of decreased length of stay or no change in cost based on ERAS implementation. CONCLUSION: While limited studies are published on the subject, ERAS implementation for radical cystectomy and laparoscopic nephrectomy improved patient-reported QOL during early phases of recovery. For radical cystectomy, there was a decreased or neutral overall financial cost associated with ERAS. Further studies assessing QOL and cost-effectiveness over the entire global period of care in a variety of urologic oncology surgeries are warranted.
Authors: A Karl; A Buchner; A Becker; M Staehler; M Seitz; W Khoder; B Schneevoigt; E Weninger; P Rittler; T Grimm; C Gratzke; C Stief Journal: J Urol Date: 2013-08-19 Impact factor: 7.450
Authors: Sebastian Karl Frees; Jonathan Aning; Peter Black; Werner Struss; Robert Bell; Claudia Chavez-Munoz; Martin Gleave; Alan I So Journal: World J Urol Date: 2017-11-07 Impact factor: 4.226
Authors: Kevin M Elias; Alexander B Stone; Katharine McGinigle; Jo'An I Tankou; Michael J Scott; William J Fawcett; Nicolas Demartines; Dileep N Lobo; Olle Ljungqvist; Richard D Urman Journal: World J Surg Date: 2019-01 Impact factor: 3.352
Authors: Simone Albisinni; Marco Moschini; Ettore Di Trapani; Francesco Soria; Andrea Mari; Atiqullah Aziz; Jeremy Teoh; Ekaterina Laukhtina; Keiichiro Mori; David D'Andrea; Diego M Carrion; Wojciech Krajewski; Mohammad Abufaraj; Alessia Cimadamore; Wei Shen Tan; Ronan Flippot; Jonathan Khalifa; Kimberly Gonsette; Benjamin Pradere Journal: World J Urol Date: 2021-06-02 Impact factor: 4.226
Authors: Juan P Cata; Miguel Patiño; Michael J Lacagnina; Jiahe Li; Aysegul Gorur; Ruben Agudelo-Jimenez; Bo Wei; Carin A Hagberg; Patrick M Dougherty; Imad Shureiqi; Peiying Yang; Peter M Grace Journal: Pain Rep Date: 2021-06-30