MP5-06 90-DAY COMPLICATIONS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY ON ENHANCED RECOVERY PROTOCOL

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2015MP5-06 90-DAY COMPLICATIONS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY ON ENHANCED RECOVERY PROTOCOL Behrod Katebian, Soroush Bazargani, Hamed Ahmadi, Gus Miranda, Jie Cai, Anne Schuckman, Siamak Daneshmand, and Hooman Djaladat Behrod KatebianBehrod Katebian More articles by this author , Soroush BazarganiSoroush Bazargani More articles by this author , Hamed AhmadiHamed Ahmadi More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.233AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Enhanced recovery after surgery (ERAS) protocol is designed to improve perioperative care and decrease hospital stay without increasing complications. We have previously shown ERAS facilitates bowel function recovery and shortens hospital stay after radical cystectomy (RC) without increasing hospital readmission rates within the first 30-days. We now evaluate our ERAS protocol for complications in the first 90 days following RC. METHODS All patients who underwent open RC with the ERAS perioperative protocol from 5/12 to 08/14 were included in the study. The protocol focuses on avoiding bowel preparation and nasogastric tube, early feeding, nonnarcotic pain management and the use of cholinergic and u-opioid antagonists. Non-consenting and patients lost to follow-up were excluded. 90-day complications (Clavien-Dindo grading system), readmissions and emergency room (ER) visits were prospectively recorded and compared to a group of matched controls (non-ERAS) who underwent RC from 10/08 to 5/12 by the same surgeons. Controls were matched by: age, sex, smoking status, BMI, Charlson comorbidity index and pathology stage. RESULTS A total of 169 consecutive patients (ERAS) and 108 controls (non-ERAS) were included in the study. The median ages of groups were 71.0 (ERAS) and 69.9 (controls). The 90-day major complication rate was 24.3%, and 22.2%; while the minor complication rate was 53.9% vs 57.4% for ERAS and controls respectively (p=0.34). Furthermore, the median number of complications per patient was 1.0 and 2.0 for ERAS and controls (p=0.29). The rate of Gastrointestinal (GI) complications (21.3 vs. 33.3%; p=0.03) and wound complications (11.8% vs. 20.4%; p=0.05) were both lower in ERAS. Finally, the 90-day readmission rate (29.6% vs 26.9%; p=0.24) and ER visit rate (37.9% vs 35.2%; p=0.20) were not different between ERAS and controls respectively. CONCLUSIONS Our ERAS protocol does not increase overall complication rates, hospital readmissions or ER visits compared to matched non-ERAS patients 90-days following RC. Furthermore, ERAS significantly reduces the frequency of GI complications during the 90-day time point. Though wound complications were lower in ERAS, the borderline p-value is inconclusive in demonstrating a reduction of complications in that category. 90-day Complications by Category Category ERAS Controls p-value Dehydration 14.2% 9.3% 0.22 Wound 11.8% 20.4% 0.05 Thromboembolism 7.7 % 9.3% 0.21 Infection 32.0% 41.7% 0.10 Cardiovascular 11.8% 13.9% 0.62 Pulmonary 4.1% 4.6% 0.85 Gastrointestinal 21.3% 33.3% 0.03 Renal/Metabolic 17.2% 23.1% 0.22 Neurologic 1.2% 1.9% 0.65 Hematological 25.4% 17.6% 0.13 Other 13.0% 7.4% 0.14 Death 4.1% 4.6% 0.85 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e47 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Behrod Katebian More articles by this author Soroush Bazargani More articles by this author Hamed Ahmadi More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...