Implementation of enhanced recovery after surgery in patients undergoing radical cystectomy: A retrospective cohort study

Abstract

BackgroundTo evaluate the feasibility and effect of implementing enhanced recovery after surgery (ERAS) in patients undergoing radical cystectomy (RC) and urinary diversion. Materials and methodsSince October 2016, a 15-point ERAS protocol has been implemented for patients undergoing elective RC and urinary diversion at Fudan University Shanghai Cancer Center (FUSCC). We retrospectively assessed patients who underwent RC performed between January 2014 and June 2018. The effects of implanting ERAS for RC were validated. ResultsA total of 443 patients were included. The ERAS and non-ERAS groups included 185 and 258 patients, respectively. There was no significant difference in the patients’ demographic characteristics, operative variables, perioperative systemic inflammation-based scores or mortality rates. Compared with the non-ERAS group, our study showed decreases in intraoperative blood loss volumes and transfusion rates in the ERAS group. Patients in the ERAS group also had earlier times to tolerate a clean liquid diet intake, first ambulation and first flatus. The incidences of postoperative pneumonia, urine leakage, intestinal obstruction and deep venous thrombosis were also significantly lower in the ERAS group. The time to pelvic drainage tube removal and the length of stay (LOS) were significantly shorter in the ERAS group than in the non-ERAS group, and the ERAS group also had a significantly lower incidence of 30-day readmission. ConclusionsThe results of this study suggest that ERAS protocols can accelerate the rehabilitation of patients undergoing RC, reduce the incidence of postoperative complications, shorten the LOS, and are safe and feasible in the field of RC. This study provides experience from FUSCC to further optimize ERAS protocols for patients with bladder cancer.