Objective
To report our center's experience with enhanced recovery after surgery (ERAS) pathway
for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day
readmissions, and hospital charges. Pathways of this type have been shown to decrease
the length of stay (LOS) and postoperative ileus. However, concerns persist that ERAS
is costly and increases readmissions. To date, limited studies have evaluated these
concerns.
Materials and Methods
Our ERAS protocol was implemented for RC in December 2015. Outcomes in ERAS patients
were compared with those in RC patients from the time period before ERAS. Patients
were excluded if they underwent concomitant nephroureterectomy.
Results
Fifty-six consecutive ERAS patients were compared with 54 pre-ERAS patients. The median
charge for index hospitalization was $31,090 in the ERAS group and $35,489 in the
pre-ERAS group (P = .036). The median LOS was 5.0 days in the ERAS group and 8.5 days in the pre-ERAS
group (P = < .001). The pre-ERAS group had a significantly increased use of nasogastric tube
(13.8% vs 30.0%) and parenteral nutrition (6.9% vs 20.4%). The overall complication
rate (including infectious, renal, deep vein thrombosis and pulmonary embolism, myocardial
infarction and stroke, and respiratory and gastrointestinal-related complications)
was similar between the 2 groups (51.7% in the ERAS group and 62.0% in the pre-ERAS
group, P = .28). Thirty- and 90-day readmissions also remained similar (19.0% vs 14.8%, P = .55, and 31.0% vs 27.7%, P = .64). The most common readmission reason was infection, specifically urinary tract
infection.
Conclusion
Implementation of the ERAS pathway at our center resulted in significantly reduced
LOS and total hospital charge, with comparable rates of complication and readmission,
highlighting the need for ERAS pathways in patients undergoing RC.
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Article info
Publication history
Published online: October 13, 2017
Accepted:
September 8,
2017
Received:
April 11,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
