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Enhanced recovery management in pediatric pyeloplasty: outcomes in a single institution and tips for improvement

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Abstract

Objective

We report the application of enhanced recovery after surgery (ERAS) regimens to pediatric patients undergoing laparoscopic pyeloplasty (LP), aiming to guide the practice of ERAS in pediatric LP.

Methods

From October 2018, we prospectively implemented a twenty-point ERAS regimen, including a modified LP procedure, for pediatric UPJO patients in a single institution. Data from 2018 to 2021 were collected and analyzed retrospectively. The variables gathered included: demographics, preoperative details and recovery elements. Outcomes were postoperative length of stay (POS), readmission rate, operation time and blood loss.

Results

A total of 75 pediatric patients (0–14 years) were included. The mean POS was 2.4 ± 1.4 days, shorter than that in recent studies in China (3.3 ± 1.4 days, 6 (3–16) days). None were redo, and six restenosis (8%) were improved after treatment with ureteral balloon dilatation. The mean operation time was 257.9 ± 54.4 min, and blood loss was 11.8 ± 10.0 ml. In the univariable analysis and multivariable analysis, no external drainage, sacral anesthesia, and withdrawal of the catheter on day one were independently associated with a POS of ≤ 2 d (p < 0.05).

Conclusion

The implementation of this ERAS protocol for pediatric LP has resulted in a shorter length of stay without a higher readmission rate. Surgery techniques, drainage management and analgesia are the key to further improvement. ERAS for pediatric pyeloplasty should be encouraged.

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Funding

No funding was received for conducting this study.

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Author notes

  1. Jiannan He and Huajian Lai have contributed equally to this study.

Authors and Affiliations

  1. Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China

    Jiannan He, Huajian Lai, Tianyou Zhang, Lei Ye, Bing Yao, Hu Qu, Bo Ma, Qiang Guo, Yifei Zhang, Jianguang Qiu & Dejuan Wang

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  1. Jiannan He
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  2. Huajian Lai
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  3. Tianyou Zhang
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  4. Lei Ye
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  5. Bing Yao
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  6. Hu Qu
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  7. Bo Ma
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  8. Qiang Guo
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  9. Yifei Zhang
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  10. Jianguang Qiu
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  11. Dejuan Wang
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Contributions

DW, JQ, JH and HL: project development, data analysis and manuscript writing. TZ, QG and YZ: data collection and data analysis. LY, BY, HQ and BM: data analysis and manuscript writing.

Corresponding authors

Correspondence to Jianguang Qiu or Dejuan Wang.

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He, J., Lai, H., Zhang, T. et al. Enhanced recovery management in pediatric pyeloplasty: outcomes in a single institution and tips for improvement. World J Urol 41, 1667–1673 (2023). https://doi.org/10.1007/s00345-023-04422-y

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  • DOI: https://doi.org/10.1007/s00345-023-04422-y

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