Reporting Radical Cystectomy Outcomes Following Implementation of Enhanced Recovery After Surgery Protocols: A Systematic Review and Individual Patient Data Meta-Analysis - Beyond the Abstract

We performed a systematic review (registered with PROSPERO: CRD42018105510) and individual patient data (IPD) meta-analysis regarding reporting of enhanced recovery after surgery (ERAS®) and radical cystectomy (RC) outcomes.1 A total of 4,197 articles were retrieved and 22 (reporting 4,048 patients) selected for review. ERAS® use was noted to result in reduced morbidity, quicker bowel recovery, and shorter length of stay (LOS). Importantly, individual participant data (IPD) were obtained for 2,077 patients from 11 studies to determine ERAS® predictors for LOS which we found no gastric tube and use local anesthesia blocks compared to regional anesthesia to be associated with reduced LOS.

While our study suggests at minimum, surgeons should adopt these ERAS® specific elements to reduce LOS following RC there are several notable findings that need to be mentioned. As noted, there are limited numbers of studies reporting RC outcomes in the context of ERAS®. Moreover, there are even fewer studies that included reporting of individual ERAS® components to study thus highlighting a need for rigorous ERAS® data reporting to improve our understanding of ERAS® and RC. The RECOvER (20 items) checklist is an excellent resource and to provide a standardized framework for ERAS® reporting.2 Our IPD data were incomplete to determine all possible ERAS components which may contribute to decreased LOS and further study with complete datasets is needed from different populations to enhance the generalizability of our findings. In summary, ERAS® pathways should be incorporated into RC (as in other surgeries) to improve patient outcomes. RC outcomes data reporting should control for the use of ERAS® components (including use of an audit system) in accordance with ERAS® Society guidelines recommendation to further improve surgical outcomes.

Written by: Stephen B. Williams, MD, MS, FACS,1 Ibrahim Jubber, MD,2 James W.F. Catto, MB, ChB, PhD, FRCS(Urol),2 and Siamak Daneshmand, MD3

  1. Division of Urology, The University of Texas Medical Branch, Galveston, Texas, United States
  2. Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
  3. USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, United States

  1. Williams, Stephen B., Marcus GK Cumberbatch, Ashish M. Kamat, Ibrahim Jubber, Preston S. Kerr, John S. McGrath, Hooman Djaladat et al. "Reporting Radical Cystectomy Outcomes Following Implementation of Enhanced Recovery After Surgery Protocols: A Systematic Review and Individual Patient Data Meta-analysis." European Urology (2020).
  2. Elias, Kevin M., Alexander B. Stone, Katharine McGinigle, I. Tankou Jo’An, Michael J. Scott, William J. Fawcett, Nicolas Demartines, Dileep N. Lobo, Olle Ljungqvist, and Richard D. Urman. "The reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) checklist: a joint statement by the ERAS® and ERAS® USA societies." World journal of surgery 43, no. 1 (2019): 1-8.
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