ACS 2018: Outcomes After Implementation of Enhanced Recovery After Surgery for Radical Cystectomy at the University of Missouri

Boston, Massachusetts ( Dr. Alex A. Henderson presented a single center experience with enhanced recovery after surgery (ERAS) pathway for radical cystectomy (RC). Their primary objectives was to evaluate effects on length of stay (LOS) and hospital costs.
They developed and implemented an ERAS protocol, termed Team InteGrated Enhanced Recovery (TIGER) with the first patient undergoing RC in March 2017. They compared outcomes in TIGER protocol patients with standard care patients from February 2016 to December 2017. Mann-Whitney U test was used and p<0.05 was considered significant. 

Thirty-five patients underwent RC during the study period. Twenty patients had standard care and 15 had the TIGER protocol. Baseline patient characteristics were similar between the two groups.
Regarding standard care vs. TIGER protocol, median hospital cost was $19,316 vs. $14,456 (p=0.089), median LOS was 10.5 days vs. 6.0 days (p=0.0274), median intraoperative blood loss was 750 mL vs. 1000 mL (p=0.100), median intraoperative fluid administration was 4975 mL vs. 2850 mL (p=0.002), median morphine milligram equivalents (MME) from postoperative day 0-3 was 413 MME vs. 275 MME (p=0.111).

In summary, the enhanced recovery protocol for RC at this institution resulted in significantly reduced LOS and intraoperative fluid administration. While not statistically significant, total cost was reduced by $4860 and postoperative MME was reduced by 43%. These findings support an integral part of all ERAS protocols which is an auditing assessment in order to implement and disseminate ERAS. This should include meticulous assessment of individual ERAS components and outcomes which should be reported using the ReCover ERAS Society publication protocol. High value care will drive these efforts and urologists have the opportunity to be at the forefront.

Presented By: Alex A. Henderson, MD, University of Missouri, Columbia, Missouri 

Written By: Stephen B. Williams, MD., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, MD. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts