LAUSR

Enhanced Recovery After Surgery (ERAS) is an approach to major elective surgery which integrates a series of strategies to improve patient experience and clinical outcomes. This is achieved by ensuring the delivery of evidence-based care – doing the right things, at the right time, more of the time. It is well established in adult practice and has been shown to reduce length of stay and complication rates and improved patient satisfaction. Despite robust evidence of benefits in adult surgical patients, there are only a handful of successful applications of ERAS protocols in the paediatric population. The few studies in general surgery and urology, all showed a decrease in length of stay and no increase in adverse incidents. Based on historical audit, we identified that patients having bladder augmentation surgery may benefit from the implementation of an ERAS protocol. Bladder augmentation is a urological procedure to increase the size of the bladder using small or large bowel. Audit data revealed that this cohort of patients did not initiate oral intake until Day 3 post-op and only started mobilising on Day 4 after the operation. Mean length of hospital stay was 9 days with a range of 7–11 days. We set up a multidisciplinary team including paediatric urologist, anaesthetist, nurses, dietician and physiotherapist to develop a formal protocol for ERAS in bladder augmentation surgery. We focused on four key elements: 1) Pre-operative planning and patient education, 2) Reducing the stress of surgery 3) Structured approach to peri and post-operative management 4) Early mobilisation and resumption of oral intake. We have launched a pilot study for which we are in the data collection phase. Early results are promising, with a reduction to mean length of stay to 8 days, earlier mobilisation and time to oral intake