MP63-12 DOES ENHANCED RECOVERY IMPACT COMPLICATIONS AFTER RADICAL CYSTECTOMY?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2016MP63-12 DOES ENHANCED RECOVERY IMPACT COMPLICATIONS AFTER RADICAL CYSTECTOMY? Erika Wood, Neema Navai, Debashish Sundi, Wei Qiao, Ashish Kamat, Colin Dinney, and Jay Shah Erika WoodErika Wood More articles by this author , Neema NavaiNeema Navai More articles by this author , Debashish SundiDebashish Sundi More articles by this author , Wei QiaoWei Qiao More articles by this author , Ashish KamatAshish Kamat More articles by this author , Colin DinneyColin Dinney More articles by this author , and Jay ShahJay Shah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.941AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Length of stay is the parameter most commonly used to evaluate the efficacy of enhanced recovery protocols. Changes to perioperative care in enhanced recovery protocols may also impact other aspects of the patient experience. We sought to characterize the impact of perioperative care approach on complications after radical cystectomy. METHODS A comprehensive multidisciplinary algorithm called the Optimized Surgical Journey (OSJ) has been in development at our institution over the last 24 months. We studied 50 patients who underwent RC with the OSJ and 50 patients who underwent RC with usual care during the same time period. Complications were categorized using Clavien-Dindo grading. All complications up to post-operative day 90 were included. Statistical analyses included the Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables. RESULTS Patients in the OSJ group had significantly fewer complications (mean per person 2.9 vs. 1.9, p=0.01). The major difference in the rate of complications was in the low-grade complications (see Table 1). The two complications that were significantly less common in the OSJ group than in the usual care group were ileus (25 vs. 7, p<.001) and constipation (12 vs 3, p=.02). In total, gastrointestinal (GI) complications (ileus, constipation, emesis, diarrhea, colitis) were notably less common in the OSJ group than the usual care group (50 versus 14 total GI complications, Table 2). CONCLUSIONS The OSJ, an enhanced recovery pathway, leads to fewer complications after radical cystectomy primarily by reduction of low-grade GI complications. The drastic reduction in GI complications may be due to omission of the bowel prep and use of non-opioid analgesics. Prospective multi-center assessment of the use of enhanced recovery in patients undergoing radical cystectomy is warranted. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e825-e826 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Erika Wood More articles by this author Neema Navai More articles by this author Debashish Sundi More articles by this author Wei Qiao More articles by this author Ashish Kamat More articles by this author Colin Dinney More articles by this author Jay Shah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...