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<p>Enhanced recovery after surgery (ERAS) pathways in urology harness multidisciplinary, evidence-based interventions to attenuate surgical stress, expedite recovery, and reduce complications. In this PRISMA-guided review of 80 core publications (23 RCTs, 6 meta-analyses, 9 systematic reviews, 15 guidelines/consensus statements, 18 observational studies, 10 narrative reviews) from 1997 to 2025, we applied ROB 2.0 and GRADE methodology to classify 20 perioperative elements. Sixteen elements—such as preoperative education, carbohydrate loading, goal-directed fluid therapy, multimodal analgesia, early mobilisation, and early oral feeding—achieved high-quality evidence with strong recommendations (A1); three elements (preoperative medical optimisation, fasting regimen, sedative use) received moderate-quality, weak recommendations (B2); and one element (audit) was supported by low-quality, weak recommendation (C2). Implementation of A1 elements in radical prostatectomy, cystectomy, and nephrectomy shortened hospital stay by 1–3&#xa0;days, cut complication rates by up to 30%, and reduced opioid consumption by approximately 30%. Key challenges include standardising fluid management for minimally invasive and outpatient procedures, improving protocol adherence, and integrating patient-reported outcomes. Future work should prioritise multicenter RCTs for moderate-evidence elements, cost-effectiveness analyses, and development of urology-specific ERAS guidelines incorporating digital monitoring and personalised risk stratification.</p>

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Evidence-based practice and future development of enhanced recovery after surgery (ERAS) in urology: a multidimensional assessment based on the GRADE system

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月7日

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  • Xuezhi Long,
  • Xiaoqin Du,
  • Yubo Wang,
  • Qiuxia Qiu,
  • Jianhao Wu,
  • Yueting Huang,
  • Zhipeng Wen,
  • Binghao Zeng,
  • Jianfeng Liang,
  • Yanchun Pan,
  • Yan Zhao,
  • Guohua Zeng,
  • Di Gu

摘要

Enhanced recovery after surgery (ERAS) pathways in urology harness multidisciplinary, evidence-based interventions to attenuate surgical stress, expedite recovery, and reduce complications. In this PRISMA-guided review of 80 core publications (23 RCTs, 6 meta-analyses, 9 systematic reviews, 15 guidelines/consensus statements, 18 observational studies, 10 narrative reviews) from 1997 to 2025, we applied ROB 2.0 and GRADE methodology to classify 20 perioperative elements. Sixteen elements—such as preoperative education, carbohydrate loading, goal-directed fluid therapy, multimodal analgesia, early mobilisation, and early oral feeding—achieved high-quality evidence with strong recommendations (A1); three elements (preoperative medical optimisation, fasting regimen, sedative use) received moderate-quality, weak recommendations (B2); and one element (audit) was supported by low-quality, weak recommendation (C2). Implementation of A1 elements in radical prostatectomy, cystectomy, and nephrectomy shortened hospital stay by 1–3 days, cut complication rates by up to 30%, and reduced opioid consumption by approximately 30%. Key challenges include standardising fluid management for minimally invasive and outpatient procedures, improving protocol adherence, and integrating patient-reported outcomes. Future work should prioritise multicenter RCTs for moderate-evidence elements, cost-effectiveness analyses, and development of urology-specific ERAS guidelines incorporating digital monitoring and personalised risk stratification.