Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Wessels, Frederik; Lenhart, Maximilian; Kowalewski, Karl‐Friedrich; Braun, Volker; Terboven, Tom; Roghmann, Florian; Michel, Maurice Stephan; Honeck, Patrick; Kriegmair, Maximilian C.

doi:10.1007/s00345-020-03133-y

Cited by 41 publications

(22 citation statements)

References 48 publications

(41 reference statements)

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“…Multivariate analysis results identified time to mobilization, time to fluid intake, and low G‐8 score as independent risk factors of POI after ICUD. Consistent with these results, most modern ERAS protocols reportedly enhance early mobilization and early oral feeding, which have shown a substantial reduction of GI complications 16,17 …”

Section: Discussionsupporting

confidence: 58%

Risk factors for postoperative ileus after robot‐assisted radical cystectomy with intracorporeal urinary diversion

et al. 2022

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Abbreviations & Acronyms ASA = American Society of Anesthesiologists BMI = body mass index CRP = C-reactive protein EBL = estimated blood loss ECUD = extracorporeal urinary diversion ERAS = enhanced recovery after surgery G-8 = Geriatric-8 GI = gastrointestinal ICUD = intracorporeal urinary diversion IQR = interquartile range iRARC = RARC with ICUD LOS = length of hospital stay MIBC = muscle invasive bladder cancer NAC = neoadjuvant chemotherapy NMIBC = nonmuscle invasive bladder cancer POI = postoperative ileus RARC = robot-assisted radical cystectomy RC = radical cystectomy ROC = receiver operating characteristic WBC = white blood cells

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Section: Discussionsupporting

confidence: 58%

Risk factors for postoperative ileus after robot‐assisted radical cystectomy with intracorporeal urinary diversion

et al. 2022

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“…In our cohort, median LOS was 7 d, with a decrease from 9 to 5 d observed over the study period. It has consistently been shown that enhanced recovery after surgery (ERAS) protocols reduce LOS, and gradual implementation of ERAS principles in our perioperative care over the study period is the likely explanation for this decrease [15] , [16] . Median DAOH increased by 4 d over the study period, reflecting that ERAS protocols reduce the duration of the index hospitalisation, but have limited effects on the postoperative course over the first 3 mo.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Days Alive and Out of Hospital Within 90 Days Following Radical Cystectomy for Bladder Cancer

Maibom

Røder

Poulsen

et al. 2021

European Urology Open Science

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Background Morbidity after radical cystectomy (RC) is usually quantified in terms of rates of complications, mortality, reoperations, and readmissions, and length of stay (LOS). The overall burden following RC within the first 90 d following RC may be better described using days alive and out of hospital (DAOH), which is a validated, patient-centred proxy for both morbidity and mortality. Objective To report short-term morbidity, LOS, and DAOH within 90 d after RC and risk factors associated with these parameters. Design, setting and participants The study included 729 patients undergoing RC for bladder cancer at a single academic centre from 2009 to 2019. Data were retrieved from national electronic medical charts. Outcome measurements and statistical analysis Multivariate analysis was used to investigate variables associated with a major complication, LOS >7 d, and DAOH <80 d. Results and limitations The 90-d complication rate was 80%, including major complications in 37% of cases. Median LOS was 7 d (interquartile range (IQR) 6–9) and median DAOH was 80 d (IQR 71–83) days. Body mass index and the Charlson comorbidity index (CCI) predicted major complications. CCI predicted LOS >7 d and DAOH <80 d. Conclusions RC was associated with significant short-term morbidity and DAOH was a good marker for cumulative morbidity after RC. We propose that DAOH should be a standard supplement for reporting surgical outcomes following RC for bladder cancer, which may facilitate better comparison of outcomes across treating institutions. Patient summary We studied complications after surgical removal of the bladder for bladder cancer. We assessed a novel patient-centred tool that more accurately describes the total burden of complications after surgery than traditional models. We found that patients with a high body mass index and coexisting chronic diseases had a higher risk of a complicated surgical course.

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“…surgery, 4 urology, 5 and thoracic surgery. 6 Their implementation within spine surgery is newer, with increasing publications in recent years.…”

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confidence: 99%

Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery

Pennington¹,

Cottrill²,

Lubelski³

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVESpine surgery has been identified as a significant source of healthcare expenditures in the United States. Prolonged hospitalization has been cited as one source of increased spending, and there has been drive from providers and payors alike to decrease inpatient stays. One strategy currently being explored is the use of Enhanced Recovery After Surgery (ERAS) protocols. Here, the authors review the literature on adult spine ERAS protocols, focusing on clinical benefits and cost reductions. They also conducted a quantitative meta-analysis examining the following: 1) length of stay (LOS), 2) complication rate, 3) wound infection rate, 4) 30-day readmission rate, and 5) 30-day reoperation rate.METHODSUsing the PRISMA guidelines, a search of the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, CINAHL, and OVID Medline databases was conducted to identify all full-text articles in the English-language literature describing ERAS protocol implementation for adult spine surgery. A quantitative meta-analysis using random-effects modeling was performed for the identified clinical outcomes using studies that directly compared ERAS protocols with conventional care.RESULTSOf 950 articles reviewed, 34 were included in the qualitative analysis and 20 were included in the quantitative analysis. The most common protocol types were general spine surgery protocols and protocols for lumbar spine surgery patients. The most frequently cited benefits of ERAS protocols were shorter LOS (n = 12), lower postoperative pain scores (n = 6), and decreased complication rates (n = 4). The meta-analysis demonstrated shorter LOS for the general spine surgery (mean difference −1.22 days [95% CI −1.98 to −0.47]) and lumbar spine ERAS protocols (−1.53 days [95% CI −2.89 to −0.16]). Neither general nor lumbar spine protocols led to a significant difference in complication rates. Insufficient data existed to perform a meta-analysis of the differences in costs or postoperative narcotic use.CONCLUSIONSPresent data suggest that ERAS protocol implementation may reduce hospitalization time among adult spine surgery patients and may lead to reductions in complication rates when applied to specific populations. To generate high-quality evidence capable of supporting practice guidelines, though, additional controlled trials are necessary to validate these early findings in larger populations.

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Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Cited by 41 publications

References 48 publications

Risk factors for postoperative ileus after robot‐assisted radical cystectomy with intracorporeal urinary diversion

Risk factors for postoperative ileus after robot‐assisted radical cystectomy with intracorporeal urinary diversion

Morbidity and Days Alive and Out of Hospital Within 90 Days Following Radical Cystectomy for Bladder Cancer

Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery

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