Decreasing length of hospital stay following radical cystectomy using multimodal enhanced recovery protocol.

Abstract

313 Background: To evaluate a peri-operative protocol to expedite recovery and decrease length of stay (LOS) without increasing readmission and complication rates after cystectomy for bladder cancer. Methods: From 5/2012 to 8/2013, a peri-operative protocol used in 126 unselected consecutive patients who underwent open cystectomy for bladder cancer with prospective follow-up. The enhanced recovery after surgery (ERAS) protocol focused on avoiding bowel prep and NGT, early feeding, minimizing narcotics and use of a μ-opioid antagonist. Exclusion was any adjunct surgery (10), previous diversion (2) and prolonged intubation (4). Time to bowel movement (BM) and regular diet, LOS, 30-day readmission and complication rates were captured. The outcomes of interest were compared to a historical cohort. Results: A total of 110 (84 male) patients were included. Median age was 69 y/o (range, 31-90). 40 (36%) patients were ≥ 75 y/o and 75 (68%) patients underwent continent diversion. 90 (82%) patients had BM and 87 (79%) were advanced to regular diet by postop day (POD) 2. Median LOS was 4 days and 63/110 (57%) discharged at or before POD 4. Five patients needed NGT due to ileus. Most common 30-day complications were anemia requiring transfusion (19%), UTI (13%) and dehydration (9%), with the latter two also being the most common etiologies for readmission. Major complications (≥ Clavian grade III) were seen in 15 (13%) patients and were significantly higher in patients ≥75 y/o than younger (22% vs. 8%; P=0.05). There was no difference in other measured outcomes with respect to age (≥75 vs. <75 y/o) and type of diversion (continent vs. incontinent). Conclusions: Our current ERAS protocol resulted in significant reduction in time to BM and LOS without increasing early readmission and complication rates. [Table: see text]