ERAS Improves Outcomes in Pediatric Urologic Reconstruction, finds study
An Enhanced Recovery After Surgery (ERAS) protocol effectively standardized perioperative care for children undergoing complex lower urinary tract reconstruction, including those with high rates of neurogenic bowel and bladder. ERAS was associated with shorter hospital stays, reduced postoperative opioid use, and fewer complications, suggesting it can safely reduce postoperative care burden while improving outcomes in this high-risk pediatric population. The study was published in JAMA Surgery by Kyle O. and colleagues.
To investigate the clinical significance of ERAS protocols, investigators conducted a prospective cohort study using eight prominent pediatric hospitals between 2017 and 2022, with the data collected in a prospective trial from July 2022 to April 2025. The patients included in the trial comprised 153 subjects aged 4 to 24 years requiring complex surgeries such as catheterizable channel creation, bladder augmentation, and bladder neck surgery; patients with uncontrolled neurogenic bowel were excluded from the trial.
The prospective patients were matched based on their propensity score to 153 historical control patients requiring the same procedures in five years before the introduction of ERAS. Standardized ERAS protocol included 20 preoperative, intraoperative, and postoperative components of care based on the evidence collected in the literature. Participants were observed post-operatively for at least one year to record protocol adherence, primary length of stay, total consumption of opioids, maximum pain scores, complications after 90 days post-operation, and 90-day balancing parameters.
Key findings:
- Median adherence to the 20-element ERAS pathway doubled, increasing from 8 measures in historical controls to 16 measures in the ERAS cohort (P < .001).
- Median primary inpatient stay decreased significantly from 8.0 days in historical controls to 5.3 days in the ERAS cohort (P < .001).
- Postoperative opioid consumption decreased by 74% in the ERAS group without any increase in maximum reported pain scores.
- Overall postoperative complication rates dropped significantly from 72.5% in the historical control group down to 60.1% in the ERAS group (P = .01).
- No statistically significant differences were observed between groups regarding 90-day emergency department visits, hospital readmissions, or unplanned reoperations.
In summary, use of the PURSUE ERAS protocol proves to be very effective in ensuring standardization of perioperative management for pediatric patients who have undergone complex lower urinary tract reconstruction. The results from this research prove that high compliance with the protocol reduces use of opioids by 74%, reduces the median duration of hospital stay by 2.7 days, and significantly reduces the rate of surgical complications within 90 days postoperatively without increased readmission risk. This proves that evidence-based ERAS pathways give better outcomes.
Reference:
Rove KO, Strine AC, Chu DI, et al. Enhanced Recovery After Surgery in Pediatric Urology Patients Undergoing Complex Lower Urinary Tract Reconstruction. JAMA Surg. Published online August 26, 2026. doi:10.1001/jamasurg.2026.3703
