Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and exploratory study
Introduction Lower urinary tract reconstruction in paediatric urology represents a physiologically stressful event that is associated with high complication rates, including readmissions and emergency room visits. Enhanced recovery after surgery (ERAS) protocol is a set of multidisciplinary, periope...
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BMJ Publishing Group
2020-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/11/e039035.full |
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| author | Kyle O Rove Andrew C Strine Duncan T Wilcox Gino J Vricella Timothy P Welch Brian VanderBrink David I Chu Rajeev Chaudhry Rebecca S Zee Megan A Brockel Douglas E. Coplen Paul F. Austin Erica J. Traxel Jacob AuBuchon Robert P. Moore Vijaya M. Vemulakonda Brian T. Caldwell Carter J. Sevick Nicholas Burjek Elizabeth B. Yerkes Yvonne Y. Chan C.D. Anthony Herndon |
| author_facet | Kyle O Rove Andrew C Strine Duncan T Wilcox Gino J Vricella Timothy P Welch Brian VanderBrink David I Chu Rajeev Chaudhry Rebecca S Zee Megan A Brockel Douglas E. Coplen Paul F. Austin Erica J. Traxel Jacob AuBuchon Robert P. Moore Vijaya M. Vemulakonda Brian T. Caldwell Carter J. Sevick Nicholas Burjek Elizabeth B. Yerkes Yvonne Y. Chan C.D. Anthony Herndon |
| author_sort | Kyle O Rove |
| collection | DOAJ |
| description | Introduction Lower urinary tract reconstruction in paediatric urology represents a physiologically stressful event that is associated with high complication rates, including readmissions and emergency room visits. Enhanced recovery after surgery (ERAS) protocol is a set of multidisciplinary, perioperative strategies designed to expedite surgical recovery without adversely impacting readmission or reoperation rates. Early paediatric urology data demonstrated ERAS reduced complications in this population.Methods and analysis In 2016, a working group of paediatric urologists and anaesthesiologists convened to develop an ERAS protocol suitable for patients undergoing lower urinary tract reconstruction and define study process measures, patient-reported outcomes and clinically relevant outcomes in paediatric and adolescent/young adult patients. A multicentre, prospective, propensity-matched, case–control study design was chosen. Each centre will enrol five pilot patients to verify implementation. Subsequent enrolled patients will be propensity matched to historical controls. Eligible patients must be aged 4–25 years and undergoing planned operations (bladder augmentation, continent ileovesicostomy or appendicovesicostomy, or urinary diversion). 64 ERAS patients and 128 controls will be needed to detect a decrease in mean length of stay by 2 days. Pilot phase outcomes include attainment of ≥70% mean protocol adherence per patient and reasons for protocol deviations. Exploratory phase primary outcome is ERAS protocol adherence, with secondary outcomes including length of stay, readmissions, reoperations, emergency room visits, 90-day complications, pain scores, opioid usage and differences in Quality of Recovery 9 scores.Ethics and dissemination This study has been registered with authors’ respective institution review boards and will be published in peer-reviewed journals. It will provide robust insight into the feasibility of ERAS in paediatric urology, determine patient outcomes and allow for iteration of ERAS implementations as new best practices and evidence for paediatric surgical care arise. We anticipate this study will take 4 years to fully accrue with completed follow-up.Trial registration number NCT03245242; Pre-results. |
| format | Article |
| id | doaj-art-4376f8bba3694df2a8ea2f92ee6b2370 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-11-01 |
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| spelling | doaj-art-4376f8bba3694df2a8ea2f92ee6b23702025-08-20T02:23:49ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-039035Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and exploratory studyKyle O Rove0Andrew C Strine1Duncan T Wilcox2Gino J Vricella3Timothy P Welch4Brian VanderBrink5David I Chu6Rajeev Chaudhry7Rebecca S Zee8Megan A Brockel9Douglas E. CoplenPaul F. AustinErica J. TraxelJacob AuBuchonRobert P. MooreVijaya M. VemulakondaBrian T. CaldwellCarter J. SevickNicholas BurjekElizabeth B. YerkesYvonne Y. ChanC.D. Anthony Herndon2 Division of Urology, Department of Surgery, University of Colorado, Aurora, Colorado, USA3 Division of Pediatric Urology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA1 Department of Pediatric Urology, Children’s Hospital Colorado, Aurora, Colorado, USA4 Division of Pediatric Urology, St Louis Children’s Hospital, St Louis, Missouri, USA1 Department of Anesthesiology – Division of Pediatric Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA3 Division of Pediatric Urology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USADivision of Urology, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA8 Division of Pediatric Urology, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA9 Division of Urology, Children’s Hospital of Richmond at VCU, Richmond, Virginia, USA10 Department of Anesthesiology, Children’s Hospital Colorado, Aurora, Colorado, USAIntroduction Lower urinary tract reconstruction in paediatric urology represents a physiologically stressful event that is associated with high complication rates, including readmissions and emergency room visits. Enhanced recovery after surgery (ERAS) protocol is a set of multidisciplinary, perioperative strategies designed to expedite surgical recovery without adversely impacting readmission or reoperation rates. Early paediatric urology data demonstrated ERAS reduced complications in this population.Methods and analysis In 2016, a working group of paediatric urologists and anaesthesiologists convened to develop an ERAS protocol suitable for patients undergoing lower urinary tract reconstruction and define study process measures, patient-reported outcomes and clinically relevant outcomes in paediatric and adolescent/young adult patients. A multicentre, prospective, propensity-matched, case–control study design was chosen. Each centre will enrol five pilot patients to verify implementation. Subsequent enrolled patients will be propensity matched to historical controls. Eligible patients must be aged 4–25 years and undergoing planned operations (bladder augmentation, continent ileovesicostomy or appendicovesicostomy, or urinary diversion). 64 ERAS patients and 128 controls will be needed to detect a decrease in mean length of stay by 2 days. Pilot phase outcomes include attainment of ≥70% mean protocol adherence per patient and reasons for protocol deviations. Exploratory phase primary outcome is ERAS protocol adherence, with secondary outcomes including length of stay, readmissions, reoperations, emergency room visits, 90-day complications, pain scores, opioid usage and differences in Quality of Recovery 9 scores.Ethics and dissemination This study has been registered with authors’ respective institution review boards and will be published in peer-reviewed journals. It will provide robust insight into the feasibility of ERAS in paediatric urology, determine patient outcomes and allow for iteration of ERAS implementations as new best practices and evidence for paediatric surgical care arise. We anticipate this study will take 4 years to fully accrue with completed follow-up.Trial registration number NCT03245242; Pre-results.https://bmjopen.bmj.com/content/10/11/e039035.full |
| spellingShingle | Kyle O Rove Andrew C Strine Duncan T Wilcox Gino J Vricella Timothy P Welch Brian VanderBrink David I Chu Rajeev Chaudhry Rebecca S Zee Megan A Brockel Douglas E. Coplen Paul F. Austin Erica J. Traxel Jacob AuBuchon Robert P. Moore Vijaya M. Vemulakonda Brian T. Caldwell Carter J. Sevick Nicholas Burjek Elizabeth B. Yerkes Yvonne Y. Chan C.D. Anthony Herndon Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and exploratory study BMJ Open |
| title | Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and exploratory study |
| title_full | Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and exploratory study |
| title_fullStr | Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and exploratory study |
| title_full_unstemmed | Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and exploratory study |
| title_short | Design and development of the Pediatric Urology Recovery After Surgery Endeavor (PURSUE) multicentre pilot and exploratory study |
| title_sort | design and development of the pediatric urology recovery after surgery endeavor pursue multicentre pilot and exploratory study |
| url | https://bmjopen.bmj.com/content/10/11/e039035.full |
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