Impact of dedicated renal enhanced recovery after surgery (RERAS) program on postoperative opioid consumption and evaluation of surgeon-specific compliance to the program.

Autor: Roebuck EH; Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC., Ivan SJ; Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC., Robinson MM; Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, NC., Worrilow WM; Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC., Gaston KE; Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC., Matulay JT; Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC., Roy OP; Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC., Clark PE; Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC., Riggs SB; Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC. Electronic address: stephen.riggs@atriumhealth.org.
Jazyk: angličtina
Zdroj: Urologic oncology [Urol Oncol] 2022 Aug; Vol. 40 (8), pp. 383.e23-383.e29. Date of Electronic Publication: 2022 Jun 22.
DOI: 10.1016/j.urolonc.2022.03.018
Abstrakt: Introduction and Objective: Enhanced Recovery After Surgery (ERAS) protocols have been increasingly applied to urologic surgeries such as cystectomy and prostatectomy, though research defining protocols and outcomes for renal ERAS programs (RERAS) for nephrectomy remains limited. We aim to assess perioperative outcomes following implementation of our RERAS protocol modified from ERAS society cystectomy guidelines, as well as describe compliance with protocol guidelines.
Methods: We performed a retrospective cohort analysis of 400 patients who underwent partial or radical nephrectomy between October 2017 and August 2020. RERAS protocol was initiated September 30, 2018, and patients were categorized into pre- and post-RERAS implementation cohorts based on surgery date. Perioperative outcomes including complications, 30-day readmissions, length of stay, and opioid consumption were compared across pre- and post-RERAS cohorts. Protocol compliance was reported based on adherence to program recommendations.
Results: Among 400 patients included in analysis, the pre-RERAS cohort included 133 patients and the post-RERAS cohort included 267 patients. There were no differences in overall complications (P = 0.354) and 30-day readmissions (P = 0.078). Length of stay (P < 0.001) and postoperative opioid consumption (P < 0.001) were significantly reduced post-RERAS. We observed an increase in compliance with RERAS recommendations over time (P< 0.001).
Conclusion: RERAS implementation was associated with decreased length of stay and opioid usage, underscoring the benefits of program adoption in an era of opioid dependence and strained hospital capacity. Successful initiation of a RERAS protocol requires intentional organization and buy in from all providers involved.
Competing Interests: Conflict of Interest No disclosures or conflicts of interest.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: