Enhanced Recovery Protocol after Radical Cystectomy for Bladder Cancer
2014; Lippincott Williams & Wilkins; Volume: 192; Issue: 1 Linguagem: Inglês
10.1016/j.juro.2014.01.097
ISSN1527-3792
AutoresSiamak Daneshmand, Hamed Ahmadi, Anne Schuckman, Anirban P. Mitra, Jie Cai, Gus Miranda, Hooman Djaladat,
Tópico(s)Colorectal Cancer Surgical Treatments
ResumoNo AccessJournal of UrologyAdult Urology1 Jul 2014Enhanced Recovery Protocol after Radical Cystectomy for Bladder Cancer Siamak Daneshmand, Hamed Ahmadi, Anne K. Schuckman, Anirban P. Mitra, Jie Cai, Gus Miranda, and Hooman Djaladat Siamak DaneshmandSiamak Daneshmand Financial interest and/or other relationship with Cubist and Endo. More articles by this author , Hamed AhmadiHamed Ahmadi More articles by this author , Anne K. SchuckmanAnne K. Schuckman Financial interest and/or other relationship with Photocure. More articles by this author , Anirban P. MitraAnirban P. Mitra More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.01.097AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Enhanced recovery after surgery protocols aim to improve patient care and decrease complications and hospital stay. We evaluated our enhanced recovery after surgery protocol, focusing on length of stay, early complication and readmission rates after radical cystectomy for bladder cancer. Materials and Methods: From May 2012 to July 2013 a perioperative protocol was applied in 126 consecutive patients who underwent open radical cystectomy and urinary diversion. Nonconsenting patients (2), those with previous diversion (2) and prolonged postoperative intubation (3), and those who underwent additional surgery (9) were excluded from study. The protocol focuses on avoiding bowel preparation and nasogastric tube, early feeding, nonnarcotic pain management and the use of cholinergic and μ-opioid antagonists. Outcomes were compared to those in matched controls from our bladder cancer database. Results: A total of 110 patients with a median age of 69 years were included in analysis, of whom 68% underwent continent urinary diversion. Of the patients 82% had a bowel movement by postoperative day 2. Median length of stay was 4 days. The 30-day minor and major complication rates were 64% and 14%, respectively. The most common minor complication was anemia requiring transfusion in 19% of patients, urinary tract infection in 13% and dehydration in 10%. The latter 2 complications were the most common etiologies for readmission. The 30-day readmission rate was 21% (23 patients). Patients 75 years old or older had a longer length of stay (5 vs 4 days, p = 0.03) and a higher minor complication rate (72% vs 51%, p = 0.04) than younger patients. Conclusions: Our enhanced recovery after surgery protocol expedites bowel function recovery and shortens hospital stay after RC and urinary diversion without an increase in the hospital readmission rates. References 1 : Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol2009; 55: 164. Google Scholar 2 : Is there a relationship between leapfrog volume thresholds and perioperative outcomes after radical cystectomy?. Urol Oncol2013; 32: 27.e7. Google Scholar 3 : The implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer. J Urol2012; 187: 2011. 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Volume 192Issue 1July 2014Page: 50-56Supplementary Materials Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordspatient readmissionurinary bladder neoplasmscystectomyrecovery of functionurinary bladderMetricsAuthor Information Siamak Daneshmand Financial interest and/or other relationship with Cubist and Endo. More articles by this author Hamed Ahmadi More articles by this author Anne K. Schuckman Financial interest and/or other relationship with Photocure. More articles by this author Anirban P. Mitra More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...
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