How the unbelievable becomes routinely believable: Advancements in peri-operative management and enhanced recovery in urology since the Eighties
Author(s):
Miss Stella Roushias
Miss Stella Roushias
Affiliations:
BAUS ePoster online library. Paramore L. 06/27/17; 177388; P5-7
Ms. Louise Paramore
Ms. Louise Paramore
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Abstract
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Introduction
For the current generation of urology registrars there is no trace of a memory of routine 2 week admissions for nephrectomies; or of cystectomy involving a month hospitalisation, bed rest and 50% transfusion rates. The advancements in minimal access surgery, anaesthetics, vessel sealing devices and leaps in post-operative multimodal management have changed modern surgery beyond belief during the progression of one generation. We aim evaluate those advancements which were once thought far-fetched, exploring their development and impact.
Methods
We evaluated historical data on blood loss, operative times, length of stay, post-operative parameters and complications for common urological surgeries and compared to contemporary series. We examined major advancements in techniques, equipment and management.
Results
The main operations of interest identified were cystectomy, nephrectomy and transurethral prostatectomy. Radical nephrectomy has been transformed from a highly morbid, long recovery procedure to a 1-2 day stay due mostly to minimal access surgery. With regards to cystectomy 1980s hospital stay averages of 20-35 days are incomparable to today’s average of around 7-8days. Step-by-step improvements within enhanced recovery programs, including reduction in opiates, earlier feeding/mobilisation in addition to bipolar/ultrasonic dissection devices and smaller incisions have had considerable impact.
Conclusion
The last 30 years have seen astounding changes in surgical techniques, peri-operative management and changing attitudes to post-operative care allowing for much reduced recovery time and complications. We must be mindful of our developments to inspire subsequent generations to avoid complacency and strive to further our current practice.
Introduction
For the current generation of urology registrars there is no trace of a memory of routine 2 week admissions for nephrectomies; or of cystectomy involving a month hospitalisation, bed rest and 50% transfusion rates. The advancements in minimal access surgery, anaesthetics, vessel sealing devices and leaps in post-operative multimodal management have changed modern surgery beyond belief during the progression of one generation. We aim evaluate those advancements which were once thought far-fetched, exploring their development and impact.
Methods
We evaluated historical data on blood loss, operative times, length of stay, post-operative parameters and complications for common urological surgeries and compared to contemporary series. We examined major advancements in techniques, equipment and management.
Results
The main operations of interest identified were cystectomy, nephrectomy and transurethral prostatectomy. Radical nephrectomy has been transformed from a highly morbid, long recovery procedure to a 1-2 day stay due mostly to minimal access surgery. With regards to cystectomy 1980s hospital stay averages of 20-35 days are incomparable to today’s average of around 7-8days. Step-by-step improvements within enhanced recovery programs, including reduction in opiates, earlier feeding/mobilisation in addition to bipolar/ultrasonic dissection devices and smaller incisions have had considerable impact.
Conclusion
The last 30 years have seen astounding changes in surgical techniques, peri-operative management and changing attitudes to post-operative care allowing for much reduced recovery time and complications. We must be mindful of our developments to inspire subsequent generations to avoid complacency and strive to further our current practice.
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