Evaluation of an enhanced recovery protocol on patients having radical cystectomy for bladder cancer

Liu, Bonnie; Domes, Trustin; Jana, Kunal

doi:10.5489/cuaj.5273

Cited by 21 publications

(18 citation statements)

References 26 publications

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“…These findings are different from that reported by Liu et al, who evaluated ERAS protocols for RC in a Canadian context. 14 They found a significantly reduced LOS in ERAS patients (median of 9 days) compared with pre-ERAS patients (median of 10 days). Some of this "ERAS" success might be attributable to cohorts where LOS is quite long to begin with (10 days), which is relatively longer than the average LOS in our institution (8 days).…”

Section: Discussionmentioning

confidence: 92%

“…ERAS protocols are standardized multimodal perioperative care pathways designed to reduce morbidity and improve operative outcomes. 14 The present study evaluated the effect of alvimopan as a critical element of our current ERAS protocol versus an ERAS protocol without alvimopan versus the standard non-ERAS protocol in accelerating GI recovery and on postoperative hospital LOS.…”

Section: Discussionmentioning

confidence: 99%

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Alvimopan as part of the Enhanced Recovery After Surgery protocol following radical cystectomy is associated with decreased hospital stay

et al. 2021

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To study the effect of alvimopan and the Enhanced Recovery After Surgery protocol on length of hospital stay in patients undergoing radical cystectomy. Methods: Our retrospective study involved 296 consecutive patients undergoing radical cystectomy for bladder cancer at our institution from 2010 through 2018. Patients were grouped according to three stages of the Enhanced Recovery After Surgery protocol implementation: (i) pre-Enhanced Recovery After Surgery (group A; n = 146); (ii) pre-alvimopan Enhanced Recovery After Surgery (group B; n = 102); and (iii) Enhanced Recovery After Surgery plus alvimopan (group C; n = 48). The primary outcome was the length of hospital stay. Secondary outcomes were time to first bowel movement, time to tolerate a regular diet, the incidence of postoperative ileus, postoperative complications and 30-day readmission rate. Results: Group C showed a significantly shorter median length of hospital stay (7 days, P = 0.003), shorter gastrointestinal recovery time (4 days, P = 0.018) and a lower rate of postoperative ileus (14.6%, P = 0.005). The reduction in length of hospital stay, gastrointestinal recovery time and a lower rate of postoperative ileus was significant after controlling for other confounders on multivariable regression analysis. With the open approach, group C showed a significantly shorter length of hospital stay and gastrointestinal recovery time (P = 0.005, P = 0.001, respectively); however, in robotic cohorts, no significant differences were observed. There was no difference among groups in the 30-day readmission rate or postoperative complications. Conclusions: Patients undergoing radical cystectomy and managed by an Enhanced Recovery After Surgery protocol experience a significantly shorter length of hospital stay when receiving alvimopan as part of the protocol. Patients seem to derive the optimum benefits of alvimopan when it is used with an open approach; however, these benefits become less obvious with the robotic approach.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Alvimopan as part of the Enhanced Recovery After Surgery protocol following radical cystectomy is associated with decreased hospital stay

et al. 2021

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“…(16,17) Liu et al, demonstrated a significant reduction in hospital length-of-stay with the implementation of ERAS protocol after RC (10.91 days versus 14.25 days; p=0.043) with no difference in 30-day readmission rates or complication rates. (18) If, on the one hand, in large volume academic referral centers in the United States, the lowest in-hospital mortality rate after 6,728 cystectomies was 0.54%, (7) on the other hand, among 7,076 patients from the SEER database, 90-day mortality was 10.75%. (19) In developing countries, reality seems to be much tougher, mainly in the public scenario.…”

Section: ❚ Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mortality after radical cystectomy is strongly related to the institution's volume of surgeries

Korkes

Cunha

Nascimento

et al. 2020

Einstein (São Paulo)

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Objective: To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center. Methods: This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay. Results: A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy / year) had a 17.5% in-hospital mortality rate. Conclusion: There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.

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Systematic Review on Enhanced Recovery and Radical Cystectomy

Goonewardene

Ventii

Bahl

et al. 2021

Management of Urology

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Evaluation of an enhanced recovery protocol on patients having radical cystectomy for bladder cancer

Cited by 21 publications

References 26 publications

Alvimopan as part of the Enhanced Recovery After Surgery protocol following radical cystectomy is associated with decreased hospital stay

Alvimopan as part of the Enhanced Recovery After Surgery protocol following radical cystectomy is associated with decreased hospital stay

Mortality after radical cystectomy is strongly related to the institution's volume of surgeries

Systematic Review on Enhanced Recovery and Radical Cystectomy

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