Simultaneous and staged surgeries in urological patients within an Enhanced Recovery After Surgery (ERAS) pathway: safety and efficacy evaluation

Introduction. Combined surgical pathology poses a dilemma between simultaneous and staged approaches. Simultaneous surgeries, performed during a single anesthetic session, reduce hospitalization time, lower anesthetic burden, however, increased operative volume and duration may elevate the risk of complications. The staged approach reduces the immediate burden on the patient but requires multiple hospitalizations, prolongs overall treatment and recovery time.

Objective. To compare clinical outcomes, length of hospitalization, postoperative complications and effectiveness of simultaneous versus staged urological surgeries within a structured enhanced recovery after surgery (ERAS) protocol.

Materials & methods. A prospective single-center randomized study evaluating the safety of simultaneous and staged urological surgeries included 78 patients with combined urological and surgical pathologies, randomized into two groups. Compliance with the ERAS protocol above 80% was a criterion for inclusion in both groups. Group 1 (n = 53) underwent simultaneous surgeries, where multiple procedures were performed during a single operative session. Group 2 (n = 25) received staged treatment, with surgical interventions separated in time. Perioperative parameters, complication rates according to the Clavien-Dindo classification, length of hospitalization, patient-reported outcomes including postoperative pain assessed by the visual analog scale (VAS), requirement for opioid analgesics, intraoperative blood loss, total duration of urinary drainage, and cumulative surgical access size were evaluated.

Results. Simultaneous surgeries demonstrated a significant reduction in overall hospitalization time (p < 0.01) and total operative time compared with staged interventions. No statistically significant differences in postoperative complication rates were observed between groups (p = 0.94).

Conclusion. Both simultaneous and staged urological surgeries are safe approaches for patients with combined pathology. Simultaneous interventions offer advantages including reduced hospitalization time without increasing the risk of postoperative complications.

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