San Diego, CA USA (UroToday.com) In the Bladder Cancer: Invasive V session at the AUA 2016 session, a poster evaluating the impact of enhanced recovery protocols after cystectomy on complication rates was presented by Dr. Erika Wood. She noted that the length of stay is the parameter most commonly used to evaluate the efficacy of enhanced recovery protocols.
Changes to perioperative care in enhanced recovery protocols may also impact other aspects of the patient experience. The authors sought to characterize the impact of perioperative care approach on complications after radical cystectomy.
An enhanced recovery protocol called the Optimized Surgical Journey (OSJ) was developed at the authors institute and implemented over the last 24 months. 50 patients who underwent RC with the OSJ and 50 patients who underwent RC with usual care during the same time period were included in this study.
Complications were categorized using Clavien-Dindo grading. All complications up to post-operative day 90 were included. Statistical analyses included the Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables.
Patients in the OSJ group developed fewer complications (95 vs. 146), mainly in the Clavien 1 and 2 groups. The two complications that were significantly less common in the OSJ group than in the usual care group were ileus (25 vs. 7, p<.001) and constipation (12 vs 3, p=.02).
The authors conclude that OSJ, their version of an enhanced recovery protocol, leads to fewer complications after radical cystectomy primarily by reduction of low-grade GI complications, probably due to omission of the bowel prep and use of non-opioid analgesics.
Presented By: Erika Wood, MD
Written By: Miki Haifler MD. Fox Chase Cancer Center, Philadelphia, PA. at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA