Challenging boundaries: an enhanced recovery programme for radical cystectomy

Abstract

INTRODUCTIONThe implementation of enhanced recovery programmes (ERPs) in colorectal surgery has seen improvements in the length of inpatient stay with no increase in complications. We investigated the role of ERP in radical cystectomy at our institution. METHODS Prospective data were collected from 26 consecutive patients prior to the introduction of the ERP and 51 patients who underwent open radical cystectomy within an ERP. Individuals in the ERP cohort did not receive bowel preparation or nasogastric drainage but received preoperative carbohydrate drinks, perioperative epidural analgesia and immediate mobilisation on day 1. Primary outcome measures included duration of intensive care unit (ICU) stay and length of hospital stay. Secondary outcome measures included the time to the passage of flatus and faeces, and time to mobilisation. Other measures that were analysed included operation time and complications. RESULTS Baseline characteristics for both groups were similar. The median length of hospital stay fell from 11.5 days to 10.4 days and the mean ICU stay dropped from 2.4 days to 1.0 days (p=0.01). Time to removal of nasogastric tube, and time to passage of flatus and faeces were significantly shorter in the ERP group, as was the time to full oral diet. Clavien complication rates and 30-day mortality rates were similar in both groups. There were no readmissions. CONCLUSIONS ERP in radical cystectomy is safe and not associated with any increase in complications or readmissions. It is associated with reductions in ICU stay, and could also reduce length of hospital stay and duration of postoperative ileus.

Enhanced Recovery Pathways Versus Standard Care After Cystectomy: A Meta-analysis of the Effect on Perioperative Outcomes

“…Although several studies have been published, striking variation exists in the effect of ERAS protocols on perioperative outcomes [4–15]. For example, some studies show that ERAS pathways can reduce the length of stay [4,6,10,11,14,16], whereas others do not [7,9,12,16]; some studies show that ERAS pathways can shorten the time to recovery of bowel activity [7,9,12], yet others do not [6,11]; some studies show that ERAS pathways can lower the rates of readmission [6,12,13]; but yet again, others do not [9,11,14]. …”

A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy

“…The FTS pathway has been used successfully in urological, 3,4 orthopaedic, 5 gynaecological 6,7 and, especially, colonic 8,9 settings. For colorectal surgery, a working group developed and modified a consensus guideline for FTS programmes in 2009.…”

Early recovery program in the radical surgical treatment of patients with prostate cancer: Experience of the specialized hospital

“…Тем не менее это положение не может быть полностью экстраполировано на уро-логические вмешательства из-за риска развития моче-вых затеков. В целом различные варианты протоколов ERAS рекомендуют как можно более раннее удаление дренажей без указания сроков [30]. В нашей работе мы отказались от назогастроинтестинальной интубации и установки дренажей во 2-й группе.…”