Presentation Authors: Brett Johnson*, Abdulhadi Akhtar, Joseph Crivelli, Ryan L Steinberg, Jun Sasaki, Austin Street, Dallas, TX, Igor Sorokin, Worcester, MA, Jodi Antonelli, Margaret Pearle, Dallas, TX
Introduction: Ureteroscopy (URS) for stone disease generates an unusually large number of unexpected patient-initiated encounters, primarily due to pain. In an effort to improve the patient experience, we developed an Enhanced Recovery After Surgery (ERAS) protocol for URS and stent placement for stones. Studies suggest there may be a prolonged benefit of ERAS. We sought to determine whether an ERAS protocol would reduce the need for patient-initiated encounters after URS.
Methods: The ERAS protocol calls for the administration of 4 medications (ketorolac, pregabalin, acetaminophen and methocarbamol) for patients undergoing URS and stent placement for stones. After a 6 month wash-in period, data were collected on 100 consecutive URS patients April 2018 - August 2018. All post-operative clinic/on-call telephone encounters ("calls"), emergency department (ED) visits, and re-admissions within 30 days after surgery were recorded. A control group of patients undergoing URS between July 2013 and November 2014, prior to ERAS protocol, served as a comparison group. Propensity score matching using age, BMI, ASA, stone burden, stone location, laterality, and operative time was performed. Statistical analysis included student's t-test and Fischer's exact.
Results: After propensity score matching, 71 pre-ERAS (median age 56.5 years IQR 45-67) and 71 post-ERAS (median age 56 years IQR 47-68) patients were evaluated. The need for ED visits and post-operative re-admission were similar between the two groups (9% pre-ERAS versus 9% post-ERAS and 3% pre-ERAS versus 4% post-ERAS, respectively, p > 0.05). A total of 98 calls was generated from 39 patients in the cohort. Calls were significantly more frequent in the pre-ERAS group than in the post-ERAS group (71 versus 27 calls, respectively, p < 0.001). Among the 71 pre-ERAS patients, 43 (61%) initiated at least 1 call versus 20 post-ERAS patients (28%) (p < 0.001). Pain-related calls were more common in pre-ERAS group versus post-ERAS group (35% vs 20%, respectively, p = 0.039, table).
Conclusions: Early analysis of an ERAS protocol for patients undergoing URS for stones shows reduced patient-initiated communication, particularly for those related to pain, suggesting that the ERAS protocol may provide benefit extending beyond day of surgery.