1. Impact of an enhanced recovery after surgery programme in radical cystectomy. A cohort-comparative study.
- Author
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Casans-Francés R, Roberto-Alcácer AT, García-Lecina AC, Ferrer-Ferrer ML, Subirá-Ríos J, and Guillén-Antón J
- Subjects
- Aged, Female, Historically Controlled Study, Hospital Mortality, Humans, Intubation, Gastrointestinal statistics & numerical data, Length of Stay statistics & numerical data, Male, Middle Aged, Patient Readmission statistics & numerical data, Postoperative Complications etiology, Postoperative Complications rehabilitation, Preoperative Care methods, Program Evaluation, Reoperation statistics & numerical data, Retrospective Studies, Urinary Bladder Neoplasms surgery, Clinical Protocols, Cystectomy rehabilitation, Postoperative Care methods, Postoperative Complications prevention & control, Urinary Diversion rehabilitation
- Abstract
Objective: To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital., Material and Methods: A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared., Results: No statistically significant differences in overall complication rate were found (73.171 vs. 77.32%; OR 1.25, 95% CI 0.54-2.981; P=.601) nor in Clavien-Dindo>2 complications (41.463 vs. 42.268%; OR 1.033, 95% CI 0.492-2.167; P=.93), mortality, lengths of stays readmission and reoperation rates. The need for nasogastric tube insertion was lower in the ERAS group (43.902 vs. 78.351%; OR 4.624, 95% CI 2.112-10.123; P<.0001), as well as the need for total parenteral nutrition (26.829 vs. 34.021%; OR 12.234, 95% CI 5.165-28.92; P<.0001), and time under endotracheal intubation since anaesthesia induction (median [IRQ]=325 (285-355) vs. 540 (360-600) min; P<.0001)., Conclusion: Enhanced recovery programs in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality., (Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2017
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