Bladder Cancer Recovery Pathways: A Systematic Review

Abstract

Background:Enhanced recovery pathways, also known as fast-track protocols, have been adopted since the early 2000s by various surgical specialties with the goal of improving patient outcomes and reducing the cost burden of major surgery on the health care system.Objective:To review the scientific literature on the origin of enhanced recovery pathways, track the contemporary utilization of such practices for patients undergoing radical cystectomy, and analyze the available data regarding their effect on morbidity, mortality, and treatment cost.Methods:A literature search of multiple electronic databases was undertaken. Manuscripts including patients undergoing radical cystectomy were chosen based on predefined criteria with an emphasis on randomized controlled trials and cohort studies. Strength of evidence for each study that met inclusion criteria was assessed based on the risk of bias, consistency, directness, and precision.Results:Database searches resulted in 1,236 potentially relevant articles. A total of 485 articles were selected for full-text dual review and 106 studies in 52 publications met the inclusion criteria.Conclusion:The utilization of enhanced recovery pathways with the goal of improving overall patient morbidity and mortality is well supported in the literature, however standardization of implementation and adherence across institutions is lacking, and their direct efficacy on reducing preventable treatment related expenditures is unconfirmed.

Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies

“…107 In addition, the stenting of the uretero-ileal anastomosis have also been shown to reduce the risk of PONV. [108][109][110] For gynecologic/oncologic surgery, general multimodal PONV prophylaxis is again recommended; regional interventions (e.g., TAP blocks) may decrease opioid use and postoperative pain, but this may not directly translate into a PONV advantage in all cases. 111,112 For cesarean delivery, specific risk factors include neuraxial anesthesia associated hypotension, reduced cardiac output from aortocaval compression, surgical stimulation, use of uterotonics, and the use of neuraxial opioids.…”

Enhanced Recovery After Surgery Protocols in Major Urologic Surgery

“…The authors furthermore proposed the implementation of “Urostomy Education Scale” ( 16 ) as an important tool for patient education in patients with urostomy after RC. Moreover, within the systematic review ( 17 ), the importance of RC patients’ participation in advocacy networks was also stressed, with the aim of improving perioperative care, both before and after surgery.…”

“…Primary conditions that have to be fulfilled before patient mobilization are the following ones: the gaining of patient’s motivation, postoperative pain relief, and the prevention of orthostatic intolerance ( 17 ). Furthermore, in the randomized study of Gatt et al ( 101 ) on colonic surgery, the implementation of structured mobility plan with an active intervention of a physiotherapist resulted in longer period of time out of bed and in increased grip strength.…”

Patients’ self‐reported nausea: Validation of the Numerical Rating Scale and of a daily summary of repeated Numerical Rating Scale scores

“…When unrecognised by health care professionals, patients' experience of PONV is an important source of dissatisfaction with care (Bamgbade et al, 2017;Roh et al, 2014) and, together with pain, is considered a major barrier to recovery (Allvin et al, 2008;Bamgbade et al, 2017). In postoperative care, fast-track surgery programmes have become increasingly practiced not only in colorectal surgery settings (Spanjersberg, Reurings, Keus, & van Laarhoven, 2011) but also in urology (Maloney, Parker, Cookson, & Patel, 2017) and orthopaedic settings (Zhu, Qian, Jiang, Ye, & Chen, 2017). To meet the goals of these programmes, preventive strategies for PONV have been incorporated in treatment protocols (Feldheiser et al, 2016).…”