Enhanced recovery after urological reconstructive surgery in pediatric patients: a systematic review and meta-analysis

Enhanced Recovery After Surgery (ERAS) is a protocol that includes rules aimed to minimize surgical stress and to reduce the post-operative period. Initially applied in intestinal surgery of adults, a recent meta-analysis suggested that ERAS is valid also in pediatric gastrointestinal surgery. This study systematically reviewed and performed a meta-analysis to evaluate ERAS benefits in pediatric urological reconstructive surgery. A PubMed search identified studies comparing ERAS and traditional protocols in pediatric urological reconstructive surgery. Data on major and minor complications, hospital readmission, and length of hospital stay were collected and analyzed. Analyses were performed using OR and Cl 95%. A p-value < 0.05 was considered significant. A total of 10 papers met the inclusion criteria, with 1410 included patients (492 ERAS group, 918 No-ERAS). There were significant differences in major complications (p < 0.001) and length of stay (p < 0.001) and the incidence of minor complications (p = 0.002) favoring patients undergoing ERAS protocol; differently, there was no difference in hospital readmission (p = 0.763). ERAS protocol is safe and feasible for children undergoing reconstructive urological surgery, reducing the risks of complications and the length of hospital stay, without increasing readmission risk. ERAS should also be a standardized procedure in pediatric reconstructive urological surgery.