PD18-06 APPLYING CLINICAL PATHWAY TO ROBOTIC CYSTECTOMY ALLOWS SHORTEST POSSIBLE LENGTH OF STAY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy and Robotics: Malignant Disease II1 Apr 2015PD18-06 APPLYING CLINICAL PATHWAY TO ROBOTIC CYSTECTOMY ALLOWS SHORTEST POSSIBLE LENGTH OF STAY Ronney Abaza Ronney AbazaRonney Abaza More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.691AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The benefit of robotic cystectomy (RC) over traditional open cystectomy continues to be called into question due to a lack of demonstrated benefits. Reported mean lengths of stay (LOS) after RC have not been significantly better than after open cystectomy, particularly when clinical pathways are used after open surgery allowing LOS of 5 to 7 days. We combined the potential advantages of minimally-invasive surgery with a clinical pathway after RC targeting discharge on the third postoperative day (POD) and report our continuing experience. METHODS A total of 78 consecutive patients undergoing RC were reviewed, excluding one patient with known advanced cardiac disease who expired postoperatively. The clinical pathway included avoidance of the intensive care unit, nasogastric tubes, and intravenous narcotics. Ketorolac and oral analgesia alone with immediate ambulation were used to encourage return of bowel function and minimize ileus. Clear liquids were given uniformly on POD#1 with regular diet given upon passing flatus. Patients were discharged when tolerating diet, with targeted discharge on POD#3. RESULTS Mean age was 68 years (35-89 years), and mean operative time was 371 minutes. Mean body mass index was 29kg/m2 (20-48), and 31% of patients had undergone neoadjuvant chemotherapy. Mean nodal yield was 30 nodes with 28% having involved nodes and a 4% positive surgical margin rate, all in pT4 patients. All patients successfully ambulated by POD#1. Only 4 patients needed any intravenous narcotics. Fifteen patients were discharged by POD#2, 35 patients on POD#3, 21 patients on POD#4, and the remaining 6 patients on POD#5 to 7. Overall mean LOS was 3.3 days (median, 3 days) with discharge by POD#3 in 65% of patients and by POD#4 in 92%. Only 2 patients were readmitted within 1 week suggesting reasonable timing of discharge as most readmissions occurred 2-4 weeks after surgery and would not have been prevented with typical, longer postoperative lengths of stay. CONCLUSIONS Applying a clinical pathway after RC allowed the shortest hospital stay after cystectomy ever reported for open, laparoscopic, or robotic surgery. This potential benefit of RC may only be apparent when a clinical pathway is used, as early ambulation, early oral intake, and intravenous narcotic avoidance is feasible after RC. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e388 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ronney Abaza More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...