Effect of a Radical Cystectomy Care Pathway on Post-Operative Length of Stay and Outcomes

To determine whether an enhance recovery protocol for radical cystectomy patient affected the length of stay or the number and type of readmissions that occurred after hospital discharge.

We prospectively assessed 152 cystectomy patients after initiation of the pathway. These patients were compared to the previous 147 patient operated on prior to the pathway initiation. Eligible patients were those undergoing radical cystectomy with any diversion at our institution. Univariate tests were performed using Wilcoxon sum-rank and chi-square tests. Multivariate analyses were performed using logistic regression models to assess for patient factors related to readmissions.

With institution of the pathway, LOS decreased from 10 to 7.1 days. Our readmission rates did not change significantly. Patients were readmitted for different reasons after pathway implementation, with the rate of UTI related readmissions increasing from 14.3% to 40.4%, but with a concomitant decrease in the rate of readmissions for wound and deep space infections from 42.9% to 23.4%. Our VTE rate decreased from 6.8% to 3.3% with implementation of the protocol.

Implementation of a cystectomy care pathway significantly decreased length of stay without an increased rate of readmissions at 30 days. No patient factors predisposed to an increased rate of readmission. Pathway implementation led to a decrease in wound and deep space infection readmissions, but was associated with an increase in UTI readmissions. Further studies are examining if early intervention can further decrease readmission rates.

Urology. 2018 Mar 12 [Epub ahead of print]

John A Brockman, Joel Vetter, Vicky Peck, Seth A Strope

Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242; St. Louis, MO 63110, USA., Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242; St. Louis, MO 63110, USA. Electronic address: .