Enhanced recovery after surgery (ERAS) following radical cystectomy: is it worth implementing for all patients?
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ORIGINAL ARTICLE
Enhanced recovery after surgery (ERAS) following radical cystectomy: is it worth implementing for all patients? Peter Hanna1 · Joseph Zabell1 · Yasser Osman2 · Mohamed M. Hussein3 · Magdy Mostafa3 · Christopher Weight1 · Badrinath Konety1 Received: 1 June 2020 / Accepted: 31 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To report the overall effect of ERAS protocol implementation in patients undergoing radical cystectomy and its impact on the length of hospital stay (LOS) and surgical outcomes considering their comorbid conditions. Methods Retrospective cohort study including 296 patients (146 non-ERAS patients vs. 150 ERAS patients) undergoing radical cystectomy and urinary diversion from 2010 to 2018. Age-adjusted Charlson Comorbidity Index (ACCI) score eight was set as cut off value between low-risk and high-risk patients. The primary outcome was LOS. Secondary outcomes were time to bowel movements, tolerance of regular diet, the incidence of postoperative ileus, postoperative complications, and 30- and 90-day readmission rates. Results A higher comorbidity burden was identified in the ERAS group compared to non-ERAS patients (p = 0.04). Median (IQR) LOS for non-ERAS was group 8(4) and 8(5) for ERAS group (p = 0.07). ERAS group demonstrated shorter time to resume bowel movements as well as time to tolerance of regular diet (p = 0.007, p = 0.023, respectively). Low-risk patients managed by the ERAS protocol demonstrated a significantly shortened gastrointestinal (GIT) recovery time (p = 0.001) as well as a reduction of LOS (p = 0.04). No significant reduction of LOS was identified for patients with higher comorbidity when placed on the ERAS protocol (p = 0.65). There were no significant differences in postoperative complications or readmission rates between groups. Conclusion ERAS protocol implementation following radical cystectomy showed significant improvements in GIT recovery, nevertheless, it did not result in a decrease in LOS or readmission rates. Low-risk patients appeared to derive more benefit from ERAS protocol implementation than high-risk patients. Keywords Enhanced recovery after surgery · Age-adjusted charlson comorbidity index · Radical cystectomy · High-risk patients
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03435-1) contains supplementary material, which is available to authorized users. * Peter Hanna [email protected] 1
Department of Urology, University of Minnesota, 420 Delaware St. S.E.MMC 394, Minneapolis, MN 55455, USA
2
Department of Urology, Mansoura Urology and Nephrology Center, Gomhoria Street, Mansoura, Dakahlia Governorate, Egypt
3
Department of Urology, Aswan University, Sahary district, Aswan, Egypt
Bladder cancer is the sixth most common cancer overall in the USA, with the eighth highest mortality [1]. Radical cystectomy (RC) and urinary diversion remain the mainstays for the treatment of muscle-invasive bladder cancer [2
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