Using an IRB approved, prospectively maintained bladder cancer database they identified patients who underwent RC with intent to cure using an ERAS protocol from 2013 to 2018. They included those with a hospital stay of 6 days or less. A post-discharge IVF regimen (average of 2 weeks, every other day with one liter of lactated ringer) was ordered for all patients. Some did not receive IVF due to insurance, non-compliance, or patient desire. Complications and readmissions were considered from respective discharge dates to postoperative days 30 and 90. Outcomes were reviewed in univariate analysis by Fisher’s exact tests and Kruskal-Wallis tests.
Out of 631 patients who underwent RC with ERAS in this time, post-discharge IVF data was available in 126 patients (IVF: 91 (72.2%), No IVF: 35 (27.8%)). Demographics were comparable between the two groups. No difference was seen in the amount of robotic surgeries performed (IVF: 29 (31.9%), No IVF: 6 (17.1%), p=0.12). Post-discharge complication rates were not significantly different between the two groups (30-d: 31.9% IVF vs 40.0% non-IVF, p=0.41; 90-d: 51.7% vs 60.0%, p=0.43). Readmission rates also were not statistically different between groups (30-d: 16.5% vs 11.4%, p=0.59; 90-d: 28.6% vs 25.7%, p=0.83).
In conclusion, no statistically significant difference in post-discharge complication rates were seen at postoperative day 30 and 90 between patients with and without post-discharge IVF. Readmission for infection and dehydration were very low in this selected population. Larger, prospective studies are needed to ascertain the benefits of outpatient IVF administration. These findings need to be interpreted in the context of costs and value based care in order to optimize outcomes at decreased costs.
Presented by: Siamak Daneshmand, MD, Associate Professor of Urology (Clinical Scholar), Director of Clinical Research, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern Califronia
Written by: Stephen B. Williams, MD, Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, Texas at the 7th ERAS World Congress, Liverpool, UK, 1-3 May 2019