MP5-07 AN EMPIRICAL EVALUATION OF VARIATION IN INTENSITY OF SURVIVORSHIP CARE AND ITS EFFECT ON KIDNEY CANCER-SPECIFIC SURVIVAL

Abstract

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 (p1⁄40.34). Furthermore, the median number of complications per patient was 1.0 and 2.0 for ERAS and controls (p1⁄40.29). The rate of Gastrointestinal (GI) complications (21.3 vs. 33.3%; p1⁄40.03) and wound complications (11.8% vs. 20.4%; p1⁄40.05) were both lower in ERAS. Finally, the 90-day readmission rate (29.6% vs 26.9%; p1⁄40.24) and ER visit rate (37.9% vs 35.2%; p1⁄40.20) 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.