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

Brooks, Nathan A., Kokorovic, Andrea, McGrath, John S., Kassouf, Wassim, Collins, Justin W., Black, Peter C., Douglas, James, Djaladat, Hooman, Daneshmand, Siamak, Catto, James W.F., Kamat, Ashish M. and Williams, Stephen B. (2020) 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 Journal of Urology, 40 (6), 1325-1342. (doi:10.1007/s00345-020-03341-6).

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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