Abstract
Purpose
Enhanced recovery after surgery (ERAS) protocols have been implemented across a variety of disciplines to improve outcomes. Herein we describe the impact of ERAS on quality of life (QOL) and cost for patients undergoing urologic oncology surgery.
Methods
A systematic literature search using the MEDLINE, Scopus, Clinictrials.gov, and Cochrane Review databases for studies published between 1946 and 2020 was conducted. Articles were reviewed and assigned a risk of bias by two authors and were included if they addressed ERAS and either QOL or cost-effectiveness for patients undergoing urologic oncology surgery.
Results
The literature search yielded a total of 682 studies after removing duplicates, of which 10 (1.5%) were included in the review. Nine articles addressed radical cystectomy, while one addressed ERAS and QOL for laparoscopic nephrectomy. Six publications assessed the impact of ERAS on QOL domains. Questionnaires used for assessment of QOL varied across studies, and timing of administration was heterogeneous. Overall, ERAS improved patient QOL during early phases of recovery within the realms of bowel function, physical/social/cognitive functioning, sleep and pain control. Costs were assessed in 4 retrospective studies including 3 conducted in the United States and one from China all addressing radical cystectomy. Studies demonstrated either decreased costs associated with ERAS as a result of decreased length of stay or no change in cost based on ERAS implementation.
Conclusion
While limited studies are published on the subject, ERAS implementation for radical cystectomy and laparoscopic nephrectomy improved patient-reported QOL during early phases of recovery. For radical cystectomy, there was a decreased or neutral overall financial cost associated with ERAS. Further studies assessing QOL and cost-effectiveness over the entire global period of care in a variety of urologic oncology surgeries are warranted.
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Acknowledgements
This study was conducted with the support of a Department of Defense Peer Reviewed Cancer Research Program (PRCRP) Career Development Award (W81XWH1710576) (SBW). Dr. Stephen B. Williams had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. We would also like to thank Julie M. Trumble and Stephen Schuenke for their efforts in preparing this manuscript for publication.
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NAB—protocol/project development, data collection or management, data analysis, manuscript writing/editing. AK—protocol/project development, data collection or management, data analysis, manuscript writing/editing. JMG—manuscript writing/editing. WK—manuscript writing/editing. JWC—manuscript writing/editing. PCB—manuscript writing/editing. JD—manuscript writing/editing. HD—manuscript writing/editing. SD—manuscript writing/editing. JWFC—manuscript writing/editing. AMK—manuscript writing/editing. SBW—protocol/project development, data collection or management, data analysis, manuscript writing/editing.
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JWFC has received reimbursement for consultancy from Astra Zeneca, Roche and Janssen, speaker fees from BMS, MSD, Nucleix and Roche, and honoraria for membership of advisory boards for Ferring, Roche and Janssen; SBW has received reimbursement for consultancy from Photocure and Taris. SBW has received travel funding from Janssen. The remaining authors have no conflicts of interest to declare.
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Brooks, N.A., Kokorovic, A., McGrath, J.S. et al. Critical analysis of quality of life and cost-effectiveness of enhanced recovery after surgery (ERAS) for patient’s undergoing urologic oncology surgery: a systematic review. World J Urol 40, 1325–1342 (2022). https://doi.org/10.1007/s00345-020-03341-6
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DOI: https://doi.org/10.1007/s00345-020-03341-6