Measuring success after radical cystectomy: Feasibility of a novel composite endpoint ("poor recovery") to quantify outcomes after surgery.

Abstract

357 Background: Given the predilection of invasive bladder cancer toward older sicker patients and the complexity of radical cystectomy (RC), it is not surprising many patients experience prolonged, difficult recoveries. There is growing interest in identifying ways to improve recovery after RC. To date, studies have focused on inpatient length of stay (LOS) as the primary measure of recovery improvement efforts. Given that many patients suffer complications after discharge and require hospital readmission, inpatient LOS may not be the most useful measure. We propose a novel endpoint – “Poor Recovery” – as a more encompassing measure of outcomes after RC. Methods: A comprehensive perioperative multidisciplinary algorithm known as the Optimized Surgical Journey (OSJ) has been in development at our institution over the last 18 months. We selected 50 patients who underwent RC with the OSJ algorithm and 50 patients who underwent RC with usual care during the same time period. Poor Recovery was defined by inpatient LOS > 7 days or hospital readmission within 30 days. Statistical analyses included Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables. Results: Patients in the OSJ group had significantly shorter times to first flatus, bowel movement, ambulation, and resumption of regular diet (Table). There were no differences between the groups in operative time, blood loss, opioid use, or rate of ICU admission. Mean LOS was significantly shorter in the OSJ group (5.6 and 8.5 days, p<0.01). Poor Recovery was experienced by 18% of the patients in the OSJ group and 70% of the patients in the non-OSJ group (p<0.01). Conclusions: We define a novel composite endpoint, Poor Recovery, that can help measure outcomes after RC. For future prospective studies of accelerated recovery pathways, the poor recovery endpoint may be a useful metric by which to determine the efficacy of various interventions. [Table: see text]