SIU 2017: The Incremental Value of an Established Enhanced Recovery after Surgery Protocol Post Open Radical Cystectomy
Between August 2013 and December 2016, all consecutive patients who underwent ORC and managed by ERAS were identified. For historical control, those who underwent ORC and managed with conventional post-operative protocols (CS) were identified. Those with follow-up period of less than 40 days were excluded. Elements of the ERAS protocol include permitting clear feeds two hours before surgery, no pre-operative mechanical bowel preparation, early removal of nasogastric tube, early feeding, deep vein thrombosis prophylaxis, use of anti-emesis, minimal post-operative antibiotics and early ambulation.
The authors identified 30 patients, with 15 patients in each group. The median and mean age, pathological stage, complication rate, median estimated blood loss and readmission rate were similar in both groups. However, the median time of ileus (defined as time to tolerate solid food) (days) varied and was CS:5 (mean 5.8, range 3-9) and ERAS:4 (mean 4.4, range 3-6) (p-value 0.01). The median length of stay (LOS) (days) was also different with CS:10 (mean 13, range 6-39) and ERAS:7 (mean 8, range 6-16) (p-value 0.01). Adoption of ERAS was associated with reduction of SS16,728 per patient per encounter.
The authors concluded that ERAS is associated with statistically significant reduction in ileus time and hospital stay. It promotes faster recovery and reduces overall healthcare cost, without compromising patient safety or readmission rates.
Presented by: Lim Y
Affiliation: Singapore General Hospital, Singapore
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal