514 ENHANCED RECOVERY AFTER SURGERY IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER

Abstract

You have accessJournal of UrologyUrothelial Cancer: Medical & Surgical Therapy1 Apr 2013514 ENHANCED RECOVERY AFTER SURGERY IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER Siamak Daneshmand, Hamed Ahmadi, Anne K. Schuckman, Gus Miranda, Anirban P. Mitra, and Hooman Djaladat Siamak DaneshmandSiamak Daneshmand Los Angeles, CA More articles by this author , Hamed AhmadiHamed Ahmadi Los Angeles, CA More articles by this author , Anne K. SchuckmanAnne K. Schuckman Los Angeles, CA More articles by this author , Gus MirandaGus Miranda Los Angeles, CA More articles by this author , Anirban P. MitraAnirban P. Mitra Los Angeles, CA More articles by this author , and Hooman DjaladatHooman Djaladat Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1908AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) with urinary diversion for bladder cancer (BC) is associated with significant peri-operative complications and prolonged hospital course. Enhanced recovery after surgery (ERAS) protocols aim to improve patient care, reduce complication rates, and shorten hospital stay. We evaluated the results of our ERAS protocol on length of stay (LOS), re-admission rate and complication rate (CR) following RC and urinary diversion for BC. METHODS Since May 2012, a new peri-operative protocol was applied for 40 consecutive unselected patients who underwent RC and urinary diversion for BC at our institution. The protocol focuses on avoiding bowel preparation and nasogastric tubes, early feeding, non-narcotic pain management, and the use of a μ-opioid antagonist. Patients who underwent additional surgery (i.e. nephrectomy) were excluded. One-month CR, LOS, and re-admission data were collected prospectively and compared with prospectively collected data from the Studer vs. T-pouch (STAR) trial (484 pts from 2002-2009). RESULTS Median age was 65 years (range 30-86). Patients' characteristics and results are summarized in table 1. There was no significant difference between the groups in terms of age, gender, or Charlson comorbidity index (p> 0.05). 33/40 (83%) patients under ERAS protocol underwent continent diversion. Median time to bowel movement was 2 days, and median LOS was 4 days (range 3-16) compared to 8 days for patients in the STAR trial (p<0.001). Thirty-day readmission rate (23%) and Clavien complication rate (63%) was not significantly different than the retrospective cohort. The most common 30-day complication and re-admission causes were UTI and dehydration/ acidosis. Major complications (≥Clavien III) were observed in 6 (15%) cases. No differences were noted in measured outcomes based on type of diversion (p=0.4). CONCLUSIONS The ERAS protocol enhances the recovery of bowel function and shortens hospital stay following RC and urinary diversion without any significant increase in early complication or hospital readmission rates. Table 1. Patients characteristics, length of stay as well as complication and readmission rates in patients on ERAS protocol compared to STAR trial ERAS STAR trial (2002-2009) P value No. (M/F) 40 (32/8) 484 (411/73) 0.3 Age (Median, range) 65 (30-86) 66 (25-89) 0.5 Charlson comorbidity index 0= 23 (57%) 0= 260 (53%) 0.6 1= 7 (17%) 1= 120 (25%) ≥ 2= 10 (25%) ≥ 2= 104 (21%) Diversion type ONB: 30 (75%) ONB (100%) CCD: 3 IC: 7 Median LOS (days) 4 (3-16) 8 (0-70) < 0.001 Re-admission rate (30 days) 9 (22.5%) 107 (22.1%) 0.9 Complication rate (30 days) 25 (62.5%) 271 (56%) 0.5 CCD, continent cutaneous diversion; ERAS, enhanced recovery after surgery; IC, ileal conduit; LOS, length of stay; ONB, orthotopic neobladder; STAR, Studer versus T pouch trial. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e210-e211 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Siamak Daneshmand Los Angeles, CA More articles by this author Hamed Ahmadi Los Angeles, CA More articles by this author Anne K. Schuckman Los Angeles, CA More articles by this author Gus Miranda Los Angeles, CA More articles by this author Anirban P. Mitra Los Angeles, CA More articles by this author Hooman Djaladat Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...