Application of the ERAs guidelines in pediatric urological surgery: a systematic review

Introduction: Consensus for enhanced recovery after Surgery (eraS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of eraS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the eraS protocol in children. eVideNCe aCQUiSiTioN: a systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 eraS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed. eVideNCe SyNTheSiS: Nine series with data from 1272 surgical pediatric cases were included. an enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and eraS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 eraS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More eraS guideline items were reported (applied or mentioned) in the most recently published studies. CoNClUSioNS: There is limited reporting and use of the eraS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. in more recent series there was an increase in eraS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.