NEAUA Main Site   | Past & Future Meetings
The New England Section of the American Urological Association
Meeting
Home
Accreditation
Information
Preliminary
Program
Registration
Information
Housing
Information
Exhibitors &
Sponsors
Local Area
Attractions

Back to 2016 Annual Meeting


Patient Outcomes Using an Enhanced Recovery Protocol After Radical Cystectomy: A Retrospective Cohort Study
Philip J. Cheng, MD, Jacqueline M. Speed, MD, Graeme S. Steele, MD, Quoc-Dien Trinh, MD, Jairam R. Eswara, MD, Steven L. Chang, MD, Adam S. Kibel, MD, Matthias F. Stopfkuchen-Evans, MD, Mark A. Preston, MD.
Brigham and Women's Hospital, Boston, MA, USA.

Background
The goal of the Enhanced Recovery after Surgery (ERAS) protocol is to reduce length of stay (LOS) and improve patient outcomes by decreasing ileus, surgical infections, and fluid overload. We evaluated our ERAS protocol for patients undergoing radical cystectomy, focusing on LOS, complication rates, and readmission.
Materials and Methods
From May to December 2015 an ERAS protocol was utilized in 62 patients who underwent open or robotic radical cystectomy and urinary diversion at our institution. 11 patients who underwent additional surgery were excluded from the study. The protocol focuses on avoidance of preoperative fasting and bowel preparation, opioid-minimizing multimodal pain management, goal-directed fluid therapy, and early postoperative feeding. Alvimopan, a peripherally acting μ-opioid antagonist, was given when available. Outcomes were compared to a cohort of patients who underwent radical cystectomy prior to instituting the ERAS protocol.
Results
A total of 51 patients with a median age of 66 years were analyzed and compared to a pre-ERAS cohort of 125 patients. The median LOS was 5 days compared to 6 days for the pre-ERAS patients. Only 4% (2 patients) of the ERAS cohort had a LOS longer than 7 days versus 32% (40 patients) of the pre-ERAS cohort. By postoperative day (POD) 3, 84% of the patients had passed flatus and 65% had a bowel movement. For the ERAS cohort, the 30-day minor and major complication rates were 55% and 12%, respectively. The most common minor complications were urinary tract infection (UTI) in 23.5% (12 patients), superficial wound infection in 16% (8 patients), and dehydration in 12% (6 patients). UTI and dehydration were the 2 most common reasons for readmission. The 30-day readmission rate was 39% (20 patients). The 39% of ERAS patients that received alvimopan had the same median LOS (5 days) as those that did not, but had an earlier median POD of flatus (2 days versus 3 days) and bowel movement (2.5 days versus 3 days).
Conclusion
Our ERAS protocol for radical cystectomy patients accelerates return of bowel function and decreases hospital length of stay compared to traditional management.


Back to 2016 Annual Meeting


Old Port
Bay by Holiday Inn
Lighthouse
© 2022 New England Section of the American Urological Association. All Rights Reserved. Privacy Policy.
Banner photo courtesty of Holiday Inn By the Bay © InterContinental Hotels.