Impact of an enhanced recovery pathway on length of stay and complications in elective radical cystectomy: a before and after cohort study

Perioperative Medicine - Tập 8 - Trang 1-10 - 2019
W. Jonathan Dunkman1, Michael W. Manning1, John Whittle1, John Hunting2, Edward N. Rampersaud3, Brant A. Inman3, Julie K. Thacker4, Timothy E. Miller1
1Division of General, Vascular and Transplant Anesthesia, Duke University, Durham, USA
2Department of Anesthesiology, Duke University, Durham, USA
3Division of Urology, Duke University, Durham, USA
4Division of Surgical Oncology, Duke University, Durham, USA

Tóm tắt

Enhanced recovery after surgery (ERAS) pathways aim to standardize and integrate perioperative care, incorporating the best available evidence-based practice throughout the perioperative period targeted at attenuating the surgical stress response while optimizing physiologic function, with the goal of facilitating recovery. Radical cystectomy is associated with significant postoperative morbidity, but comprehensive ERAS pathways have not been well studied in this population. This is a before and after cohort study of an ERAS pathway for radical cystectomy at a large academic medical center. Following introduction of the ERAS pathway and a wash in period, we prospectively collected data from the next 100 consecutive subjects undergoing radical cystectomy with the ERAS pathway. This cohort was compared to a retrospective cohort of 100 consecutive patients undergoing radical cystectomy with traditional care. The primary outcome was hospital length of stay. Secondary outcomes included perioperative management, time to recovery milestones, complications, and costs. Implementation of an ERAS pathway for radical cystectomy was associated with reduced hospital length of stay (median LOS 10 days (IQR = 8–18) vs 7 days (IQR = 6–11); p < 0.0001), reduced time to key recovery milestones, including days to first stool (5.83 vs 3.99; p < 0.001) and days to first solid food (9.68 vs 3.2; p < 0.001), reductions in some complications, and a 26.6% reduction in overall costs (p < 0.001). Our data support the use of an ERAS pathway for radical cystectomy and add to the increasing body of literature supporting enhanced recovery over a wide variety of procedures. Not applicable.

Tài liệu tham khảo

Arumainayagam N, McGrath J, Jefferson KP, Gillatt DA. Introduction of an enhanced recovery protocol for radical cystectomy. BJU Int. 2008;101(6):698–701.

Baack Kukreja JE, Kiernan M, Schempp B, et al. Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study. BJU Int. 2017;119(1):38–49.

Bazargani ST, Djaladat H, Ahmadi H, et al. Gastrointestinal complications following radical cystectomy using enhanced recovery protocol. Eur Urol Focus. 2017;4(6):889-94.

Cerantola Y, Valerio M, Persson B, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations. Clin Nutr. 2013;32(6):879–87.

Daneshmand S, Ahmadi H, Schuckman AK, et al. Enhanced recovery protocol after radical cystectomy for bladder cancer. J Urol. 2014;192(1):50–6.

Di Rollo D, Mohammed A, Rawlinson A, Douglas-Moore J, Beatty J. Enhanced recovery protocols in urological surgery: a systematic review. Can J Urol. 2015;22(3):7817–23.

Elias KM, Stone AB, McGinigle K, et al. The reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) checklist: a joint statement by the ERAS® and ERAS® USA societies. World J Surg. 2018;43:1–8.

Jensen BT, Petersen AK, Jensen JB, Laustsen S, Borre M. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial. Scand J Urol. 2015;49(2):133–41.

Kehlet H. Postoperative ileus—an update on preventive techniques. Nat Rev Gastroenterol Hepatol. 2008;5(10):552.

Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189–98.

Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg. 2007;245(6):867.

Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961–9.

Lee CT, Chang SS, Kamat AM, et al. Alvimopan accelerates gastrointestinal recovery after radical cystectomy: a multicenter randomized placebo-controlled trial. Eur Urol. 2014;66(2):265–72.

Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292–8.

Maffezzini M, Gerbi G, Campodonico F, Parodi D. Multimodal perioperative plan for radical cystectomy and intestinal urinary diversion. I. Effect on recovery of intestinal function and occurrence of complications. Urology. 2007;69(6):1107–11.

Miller TE, Thacker JK, White WD, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014;118(5):1052–61.

Mir MC, Zargar H, Bolton DM, Murphy DG, Lawrentschuk N. Enhanced recovery after surgery protocols for radical cystectomy surgery: review of current evidence and local protocols. ANZ J Surg. 2015;85(7–8):514–20.

Patel SY, Getting REG, Alford B, et al. Improved outcomes of Enhanced Recovery After Surgery (ERAS) protocol for radical cystectomy with addition of a multidisciplinary care process in a US comprehensive cancer care center. World J Surg. 2018;42:1–7.

Pruthi RS, Nielsen M, Smith A, Nix J, Schultz H, Wallen EM. Fast track program in patients undergoing radical cystectomy: results in 362 consecutive patients. J Am Coll Surg. 2010;210(1):93–9.

Roth B, Birkhäuser FD, Zehnder P, et al. Parenteral nutrition does not improve postoperative recovery from radical cystectomy: results of a prospective randomised trial. Eur Urol. 2013;63(3):475–82.

Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55(1):164–76.

Tyson MD, Chang SS. Enhanced recovery pathways versus standard care after cystectomy: a meta-analysis of the effect on perioperative outcomes. Eur Urol. 2016;70(6):995–1003.

Wind J, Polle S, Fung Kon Jin P, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93(7):800–9.

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Perioperative Medicine

Tập 8

1-10

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