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ERAS Society 2019: Decreasing Readmission Rates Following Major Urologic Surgery

Liverpool, United Kingdom (UroToday.com) Dr. Ilaria Lucca, from the University Hospital of Lausanne, Lausanne, Switzerland, reviewed predictors and interventions to decreasing readmission rates following major urologic surgery. Readmission rates following surgery are well known with radical cystectomy being the cornerstone for significantly high readmission rates (15-25% at 30 days) despite refinement in surgical techniques. Radical cystectomy patients may benefit from ERAS pathways because of the complexity of the surgery and high rate of complications (estimated 60-70%) even in high-volume centers.

Despite the implementation of ERAS pathways worldwide, length of stay is prolonged among radical cystectomy patients in Europe vs. the theUnited States. Possible explanations include different health systems, no alvimopan available in Europe, reimbursement structure and cultural differences. Further adding to the complexity are systematic review and meta-analyses showing no significant reduction in readmission rates following implementation of ERAS pathways. Certain independent studies have reported decreased costs and length of stay associated with ERAS, however, readmission rates remain unaltered. One study performed by Pang et al. in European Urology found patients who underwent radical cystectomy with ERAS had 15% 30-day readmission rates compared to 25% of those without ERAS (p=0.04).

It should be noted this study had an ERAS auditing system ensuring all elements of ERAS enforced in a high-volume center. Infection and dehydration remain the top causes for readmission following radical cystectomy and targeted interventions to reduce these complications may reduce readmission rates following radical cystectomy. In conclusion, ERAS protocols may not reduce readmission rates and shorter length of stay may not increase readmission rates. The anticipation of complications with dedicated follow-up plan (early check-up, home visits, the inclusion of other providers, digital communication) may ameliorate readmission rates following radical cystectomy.


Presented by: Ilaria Lucca, MD, Lausanne University Hospital, Lausanne, Switzerland

Written by Stephen B. Williams, MD, FACS, Chief of the Division of Urology, Associate Professor, Urology and Radiology, The Robert Earl Cone Professorship, Director of Urologic Oncology, Director of Urologic Research, Co-Director Department of Surgery Clinical Outcomes Research Program, The University of Texas Medical Branch, UTMB Health, Galveston, Texas at the 7th ERAS World Congress, Liverpool, UK, 1-3 May 2019.