enhanced Recovery After Surgery (ERAS).pdf

CUAJ ? October 2011 ? Volume 5, Issue 5 ? 2011 Canadian Urological Association 342 review Cite as: Can Urol Assoc J 2011;5(5): 342-8;DOI:10.5489/cuaj.11002 Abstract Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer. Despite improvements in surgical technique, anesthe- sia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Enhanced recovery after sur- gery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the pro- found stress response following surgery. The key elements of ERAS protocols include preoperative counselling, optimization of nutri- tion, standardized analgesic and anesthetic regimens and early mobilization. Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow. The present article discusses particular aspects of ERAS proto- cols which represent fundamental shifts in surgical practice, includ- ing perioperative nutrition, management of postoperative ileus and the use of mechanical bowel preparation. Introduction Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer.1 Despite improvements in surgi- cal technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Overall complication rates have been reported as high as 64% at 90 days,2 with an average in-patient stay of 17.4 days.3 Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways desig