Towards a 4-day length of stay after radical cystectomy; Introducing enhanced recovery program in a new robotic cystectomy service
Author(s):
Mr Dimitrios Moschonas
,
Mr Dimitrios Moschonas
Affiliations:
Mr Ricardo Soares
,
Mr Ricardo Soares
Affiliations:
Mr Pavlos Pavlakis
,
Mr Pavlos Pavlakis
Affiliations:
Mr Murthy Kusuma
,
Mr Murthy Kusuma
Affiliations:
Ms Alison Roodhouse
,
Ms Alison Roodhouse
Affiliations:
Dr Chris Jones
,
Dr Chris Jones
Affiliations:
Mr Hugh Mostafid
,
Mr Hugh Mostafid
Affiliations:
Mr Simon Woodhams
,
Mr Simon Woodhams
Affiliations:
Mr Michael Swinn
,
Mr Michael Swinn
Affiliations:
Mr Matthew Perry
,
Mr Matthew Perry
Affiliations:
Mr Krishnaji Patil
Mr Krishnaji Patil
Affiliations:
BAUS ePoster online library. Moschonas D. 06/26/17; 177336; P1-8
Dr. Dimitrios Moschonas
Dr. Dimitrios Moschonas
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Abstract
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Aim Our aim was to evaluate enhanced recovery protocol (ERP) after robotic assisted radical cystectomy (RARC) in a de novo cystectomy service, focusing on length of stay (LOS) and complication rates, as key performance indicators that attest to quality of care.
Patients and methods: After the establishment of a regional tertiary bladder cancer service in 2013 170 patients underwent RARC with a newly devised multidisciplinary ERP. Prospectively collected demographic, operative and perioperative data from institutional database were analysed.
Results The median age at treatment was 71 years old, 77.3% were males, 73% had a BMI <30kg/m2, 27.4% a CPET anaerobic threshold <11 and 84.3% an ASA score ≤2. The median LOS was 5 days (1st-3rd IQR: 4-7 days). Post-operative day 4 was the most frequent day of discharge from hospital. Age (p=0.003) and complications (p<0.001) were the only factors that showed a statistically significant association with a 4-day LOS. The incidence of post-treatment complications was 40% (68 of 170) for minor (Clavien-Dindo grade ≤II) and 7% (12 of 170) for major (grade ≥III) complications. There was one death (0.67%) within 30 days of surgery.
Conclusions: Full engagement of the entire fine tuned team to the multimodal ERP combined with reduced surgical stress by minimal invasive approach resulted in a LOS of four days in the largest proportion of patients and low rates of major complications. Elderly patients could get benefit from prehabilitation program and closer perioperative monitoring whilst neoadjuvant chemotherapy and intracorporeal diversion do not seem to affect outcomes.
Aim Our aim was to evaluate enhanced recovery protocol (ERP) after robotic assisted radical cystectomy (RARC) in a de novo cystectomy service, focusing on length of stay (LOS) and complication rates, as key performance indicators that attest to quality of care.
Patients and methods: After the establishment of a regional tertiary bladder cancer service in 2013 170 patients underwent RARC with a newly devised multidisciplinary ERP. Prospectively collected demographic, operative and perioperative data from institutional database were analysed.
Results The median age at treatment was 71 years old, 77.3% were males, 73% had a BMI <30kg/m2, 27.4% a CPET anaerobic threshold <11 and 84.3% an ASA score ≤2. The median LOS was 5 days (1st-3rd IQR: 4-7 days). Post-operative day 4 was the most frequent day of discharge from hospital. Age (p=0.003) and complications (p<0.001) were the only factors that showed a statistically significant association with a 4-day LOS. The incidence of post-treatment complications was 40% (68 of 170) for minor (Clavien-Dindo grade ≤II) and 7% (12 of 170) for major (grade ≥III) complications. There was one death (0.67%) within 30 days of surgery.
Conclusions: Full engagement of the entire fine tuned team to the multimodal ERP combined with reduced surgical stress by minimal invasive approach resulted in a LOS of four days in the largest proportion of patients and low rates of major complications. Elderly patients could get benefit from prehabilitation program and closer perioperative monitoring whilst neoadjuvant chemotherapy and intracorporeal diversion do not seem to affect outcomes.
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