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Implementierung des ERAS®-Protokolls (Enhanced Recovery After Surgery) nach radikaler Zystektomie an der Universitätsmedizin Mainz

Implementation of Enhanced Recovery after Surgery (ERAS®) protocol in radical cystectomy at the University Medical Center Mainz

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Zusammenfassung

Hintergrund

In chirurgischen Fachdisziplinen zeichnet sich im Hinblick auf die Prä- und Rehabilitation des Patienten in den letzten Dekaden ein Paradigmenwechsel ab. Insbesondere kann nach aktueller Studienlage bei komplikationsträchtigen Operationen wie der radikalen Zystektomie durch enge interdisziplinäre Zusammenarbeit die perioperative Betreuung des Patienten im Sinne einer Fast-track-Genesung optimiert werden.

Fragestellung

Konzeption standardisierter Behandlungsabläufe und Erstellung eines konkreten Maßnahmenkatalogs nach radikaler Zystektomie orientierend an den Leitlinien der ERAS®-Society.

Ergebnisse

Das präsentierte Programm beginnt bei der präoperativen Schulung des Patienten zur optimalen körperlichen und geistigen Vorbereitung auf die Operation. Wesentliche peri- und postoperative Aspekte sind eine schonende Operationstechnik, suffiziente Schmerztherapie, frühzeitige Mobilisierung und Kostzufuhr, zügige Entfernung von Fremdmaterial und die frühestmögliche Rückkehr in den Alltag.

Diskussion

Prospektive Datenanalysen bezüglich der Wirksamkeit der etablierten Maßnahmen insbesondere in Bezug auf postoperative Komplikationen und mediane Hospitalisationsdauer sind die nächste Zielsetzung.

Abstract

Background

In surgical fields there has been a perceivable paradigm shift during the last decade concerning patient pre- and rehabilitation. Current literature suggests close interdisciplinary collaboration after complex procedures such as radical cystectomy in order to optimize perioperative patient care for the benefit of “fast-track” surgery.

Objectives

To compose a catalogue of standardized measures after radical cystectomy based on guidelines set by the ERAS®-Society.

Results

The protocol commences with preoperative education in order to improve the physical and psychological condition of the patient. Crucial aspects in peri- and postoperative patient care are gentle surgical technique, adequate pain management, early mobilization and oral food intake, early removal of drains and foreign material and a seamless return to normal, daily life.

Conclusions

Prospective data analysis will be the next step in order to establish the effectiveness of the protocol especially regarding postoperative complications and median duration of hospital stay.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie und Kinderurologie der Universitätsmedizin, Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    N. D. Fischer, S. Epple, A. Haferkamp & W. Jäger

  2. Klinik für Anästhesiologie und Intensivmedizin der Universitätsmedizin, Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland

    E. Wittenmeier

  3. Institut für Physikalische Therapie, Prävention und Rehabilitation der Universitätsmedizin, Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland

    U. Betz

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  1. N. D. Fischer
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  2. S. Epple
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  3. E. Wittenmeier
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  4. U. Betz
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  5. A. Haferkamp
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Corresponding author

Correspondence to N. D. Fischer.

Ethics declarations

Interessenkonflikt

N. D. Fischer, S. Epple, E. Wittenmeier, U. Betz, A. Haferkamp und W. Jäger geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Fischer, N.D., Epple, S., Wittenmeier, E. et al. Implementierung des ERAS®-Protokolls (Enhanced Recovery After Surgery) nach radikaler Zystektomie an der Universitätsmedizin Mainz. Urologe 60, 169–177 (2021). https://doi.org/10.1007/s00120-020-01430-3

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