AUA 2019: Review of Enhanced Recovery after Surgery Pathway for the Perioperative Management of Abdominal Sacrocolpopexy

Chicago, IL ( The enhanced recovery pathways after surgery (ERAS) have been shown to reduce surgical morbidity and length of stay across various procedures. The authors aimed to provide a framework for standardized perioperative management for women undergoing abdominal sacrocolpopexy (ASC) for pelvic organ prolapse. They used the PRISMA statement, a systematic review of the literature was conducted using Pubmed.

They included 513 abstracts identified, 33 full-text papers were included for final review. ERAS items with available data specific to ASC were: patient education, medical comorbidities, preoperative bowel preparation, minimally-invasive approach (MIS), prophylactic antibiotics, epidural analgesia, postoperative: urinary drainage, ileus, analgesia and early mobilization. No data existed on the following elements: preanesthesia medications, venous thromboembolism, skin preparation, standard anesthetic protocol, perioperative fluid management, and prevention of postoperative nausea/vomiting. Key principles appear to be appropriate preoperative counseling with a focus on patient literacy, no benefit with preoperative bowel preparation or prophylactic antibiotic use, improved outcomes with MIS and addition of spinal anesthesia. Limiting opioid use postoperatively and early mobilization appear to be beneficial but with little supporting evidence. Early urethral catheter removal benefit is unclear.

The author at the ends concluded that there exists limited data regarding ERAS principles in perioperative care of patients undergoing ASC, and the need prospective studies with implementation of these principles are needed to assess impact on postoperative care of these patients.

Presented by: Amy Nemirovsky, medical student, University of Maryland School of Medicine 

Co-Authors: Rena D Malik MD, Baltimore,MD

Written by: Bilal Farhan, MD, Clinical Instructor, Female Urology and Voiding Dysfunction, Department of Urology, University of California, Irvine Twitter: @BilalfarhanMD at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois