Enhanced recovery augments ability of intracorporeal robotic assisted radical cystectomy to reduce length of stay making comparisons between open and robotic cystectomy meaningless outside of a randomised trial.
Author(s):
Mr Wei Shen Tan
,
Mr Wei Shen Tan
Affiliations:
Mr Benjamin Lamb
,
Mr Benjamin Lamb
Affiliations:
Miss Mae-Yen Tan
,
Miss Mae-Yen Tan
Affiliations:
Mr Ashwin Sridhar
,
Mr Ashwin Sridhar
Affiliations:
Ms Anna Mohammed
,
Ms Anna Mohammed
Affiliations:
Ms Hiliary Baker
,
Ms Hiliary Baker
Affiliations:
Mr Senthil Nathan
,
Mr Senthil Nathan
Affiliations:
Mr Timothy Briggs
,
Mr Timothy Briggs
Affiliations:
Dr Melanie Tan
,
Dr Melanie Tan
Affiliations:
Prof John Kelly
Prof John Kelly
Affiliations:
BAUS ePoster online library. Tan W. 06/26/17; 177334; P1-6 Disclosure(s): research grants from the Urology Foundation and Mason Medical Research Trust
Dr. Wei Shen Tan
Dr. Wei Shen Tan
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Abstract
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Introduction
Postoperative complications and prolonged length of stay (LOS) is common following radical cystectomy. Enhanced recovery (ER) is increasingly adopted and improves perioperative outcomes. We investigate the impact of ER and mode of surgery on LOS.

Methods
Between Feb 2009 and Oct 2017, 334 radical cystectomy cases were performed at our institution (98 ORC, 236 RARC). We identified 45 consecutive ORC cases performed without ER before the commencement of the RARC programme (Cohort A), 50 consecutive iRARC cases performed without an ER pathway (Cohort B) and 40 iRARC cases with a well-structured ER pathway (Cohort C). Primary outcome measure was LOS while secondary outcome measures included perioperative 30-day complications and readmission rates. Complications were accessed using the Clavian-Dindo classification.

Results
There were significant differences in median LOS between Cohort A (16 days, IQR: 12.5-20.5), Cohort B (10.0 days, IQR: 7-15.0) and Cohort C (7 days, IQR: 7.0-10.0) (p=0.007). Significantly more cases of continent urinary diversion were performed in Cohort C (35.5%, 11/40) compared to Cohort A (15.6%, 7/45) and Cohort B (20%, 10/50). There was no significant difference in 30-day readmission rates and 30-day mortality although 30-day perioperative complications were significantly lower in Cohort C.

Conclusion
A structured ER programme can significantly reduce LOS in patients undergoing iRARC without increasing 30-day readmission rates. In studies comparing ORC and RARC, the presence or absence of an ER programme will be a confounding factor when interpretating perioperative outcomes following ORC and RARC and only level I evidence can be interpreting reliably.
Introduction
Postoperative complications and prolonged length of stay (LOS) is common following radical cystectomy. Enhanced recovery (ER) is increasingly adopted and improves perioperative outcomes. We investigate the impact of ER and mode of surgery on LOS.

Methods
Between Feb 2009 and Oct 2017, 334 radical cystectomy cases were performed at our institution (98 ORC, 236 RARC). We identified 45 consecutive ORC cases performed without ER before the commencement of the RARC programme (Cohort A), 50 consecutive iRARC cases performed without an ER pathway (Cohort B) and 40 iRARC cases with a well-structured ER pathway (Cohort C). Primary outcome measure was LOS while secondary outcome measures included perioperative 30-day complications and readmission rates. Complications were accessed using the Clavian-Dindo classification.

Results
There were significant differences in median LOS between Cohort A (16 days, IQR: 12.5-20.5), Cohort B (10.0 days, IQR: 7-15.0) and Cohort C (7 days, IQR: 7.0-10.0) (p=0.007). Significantly more cases of continent urinary diversion were performed in Cohort C (35.5%, 11/40) compared to Cohort A (15.6%, 7/45) and Cohort B (20%, 10/50). There was no significant difference in 30-day readmission rates and 30-day mortality although 30-day perioperative complications were significantly lower in Cohort C.

Conclusion
A structured ER programme can significantly reduce LOS in patients undergoing iRARC without increasing 30-day readmission rates. In studies comparing ORC and RARC, the presence or absence of an ER programme will be a confounding factor when interpretating perioperative outcomes following ORC and RARC and only level I evidence can be interpreting reliably.
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