The BAUS Enhanced Recovery Pathway (ERP)
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Transcript of The BAUS Enhanced Recovery Pathway (ERP)
The British Association of Urological Surgeons Date of publication: December 2015 Date of next review: December 2017
THE BRITISH ASSOCIATION OF UROLOGICAL SURGEONS
35-43 Lincolns Inn Fields
London
WC2A 3PE
Telephone +44 (0)20 7869 6950
Facsimile +44 (0)20 7404 5048
Internet www.baus.org.uk
Email admin@baus.org.uk
BAUS Enhanced Recovery Pathway
PREPARED BY THE BAUS ERP GROUP
Jon Cartledge - Leeds Malcolm Crundwell Exeter
Mark Daugherty - Exeter Kim Davenport - Cheltenham
Anurag Golash Stoke on Trent
David Gillatt - Bristol Gurminder Mann Nottingham John McGrath - Exeter Toby Page Newcastle upon Tyne Julian Smith - Southampton
Document design by Nigel Bullock - Cambridge
BAUS Enhanced Recovery Pathway - Page 2
CONTENTS
FOREWORD by Mr Mark Speakman, President of BAUS ..................................................... 5
1 INTRODUCTION ............................................................................................................................. 6
2 OVERVIEW ....................................................................................................................................... 7
2.1 What is enhanced recovery? .............................................................................................. 7
2.2 The components of an enhanced recovery programme .......................................... 7
2.2.1 Primary care .................................................................................................................................. 7
2.2.2 Outpatients ..................................................................................................................................... 7
2.2.3 Pre-admission ............................................................................................................................... 8
2.2.4 Day of surgery ............................................................................................................................... 8
2.2.5 Peri- and intra-operative .......................................................................................................... 8
2.2.6 Post-operative ............................................................................................................................... 8
2.2.7 Follow-up ........................................................................................................................................ 9
2.2.8 Summary ......................................................................................................................................... 9
3 PREPARATION FOR SURGERY ................................................................................................... 9
3.1 Primary care......................................................................................................................... 10
3.2 Outpatient clinic ................................................................................................................. 10
3.3 Pre-admission clinic .......................................................................................................... 12
3.4 Day of surgery admission ................................................................................................ 13
4 ANALGESIA & ANAESTHESIA .................................................................................................. 14
4.1 Pre-operative ....................................................................................................................... 14
4.2 Operative ............................................................................................................................... 14
4.2.1 Intraoperative neural blockade ........................................................................................... 14
4.2.2 Fluid management .................................................................................................................... 15
4.2.3 Anaesthetic agents ................................................................................................................... 15
4.2.4 Antiemetics.................................................................................................................................. 15
BAUS Enhanced Recovery Pathway - Page 3
4.2.5 Avoidance of hypothermia .................................................................................................... 15
4.2.6 Antibiotic prophylaxis............................................................................................................. 15
4.2.7 Extended VTE prophylaxis .................................................................................................... 16
4.3 Post-operative ..................................................................................................................... 16
4.3.1 Avoiding opiates ........................................................................................................................ 16
4.3.2 Avoiding patient-controlled analgesia (PCA) ................................................................ 16
4.3.3 Post-operative analgesic strategy ...................................................................................... 16
5 DRAINS ........................................................................................................................................... 17
5.1 Renal surgery ....................................................................................................................... 17
5.2 Pelvic surgery ...................................................................................................................... 18
5.3 Summary of recommendations ..................................................................................... 18
5.3.1 Renal surgery ............................................................................................................................. 18
5.3.2 Pelvic surgery ............................................................................................................................. 18
6 URINARY CATHETERS ............................................................................................................... 18
6.1 Renal surgery ....................................................................................................................... 18
6.2 Pelvic surgery ...................................................................................................................... 19
6.3 Summary of recommendations ..................................................................................... 19
7 MOBILISATION ............................................................................................................................ 20
8 NUTRITION ................................................................................................................................... 20
8.1 Pre-operative ....................................................................................................................... 20
8.1.1 Fasting ........................................................................................................................................... 20
8.1.2 Carbohydrate supplementation .......................................................................................... 20
8.1.3 Prevention of ileus .................................................................................................................... 21
8.2 Post-operative ..................................................................................................................... 22
9 DISCHARGE CRITERIA .............................................................................................................. 22
10 IMPLEMENTATION .................................................................................................................. 23
11 REFERENCES .............................................................................................................................. 23
12 APPENDIX ................................................................................................................................... 29
BAUS Enhanced Recovery Pathway - Page 4
12.1 Procedure-specific checklists ...................................................................................... 29
12.1.1 Renal surgery checklist ........................................................................................................ 29
12.1.2 Pelvic surgery checklist ....................................................................................................... 29
12.2 Information for clinicians ............................................................................................. 30
13 DISCLAIMER ............................................................................................................................... 30
BAUS Enhanced Recovery Pathway - Page 5
FOREWORD by Mr Mark Speakman, President of BAUS
This document has been designed as pragmatic guidance for urology
units looking to implement enhanced recovery protocols (ERPs) across
various types of major urological surgery.
It is not intended to be proscriptive, because we recognise that many
units achieve excellent clinical results despite variation in aspects of
clinical care between indiv
