Advertisement

Enhanced Recovery After Surgery in the Urinary Diversion Population: Are Protocols Applied Differently in the Benign Indication Population?

      Abstract

      Objective

      To retrospectively evaluate enhanced recovery after surgery (ERAS) protocol administration, hospital length of stay, 30-day readmission, and complication rates among cystectomy and/or urinary diversion patients with benign or malignant indication.

      Materials and methods

      Data was extracted retrospectively for cystectomy and/or urinary diversion performed at our institution from June 2016 to May 2019. Descriptive statistics, Chi squared, Wilcoxon rank-sum, binary logistic regression, and linear regression functions in R 4.0.4 (R Foundation), R Package “Tidverse” V1.3.0.9, and RStudio V1.44.1106 (RStudio, PBC) were used to analyze data.

      Results

      102 patients met selection criteria with 36 and 66 patients in the benign and malignant indication cohorts, respectively. Significant differences between cohorts included BMI, age, opioid exposure, and spinal anomalies. The malignant cohort had higher ERAS completion rates for preoperative and intraoperative protocols (41% and 53% vs 14% and 19%). The mean ERAS item administration for benign and malignant indication patients differed significantly (2.9 vs 4.2, P < 0.01). Logistic regression demonstrated benign indication was significantly associated with ERAS failure (OR 4.25, 95% CI 1.18 – 21.03, P = 0.043). Higher ERAS item administration sum was associated with shorter hospitalizations and lower complication rates (P = < 0.01, P = 0.019). No association was observed for 30-day readmission.

      Conclusion

      The benign urinary diversion/cystectomy population more frequently possesses characteristics adverse to ERAS protocol completion and in our study received fewer ERAS protocol items. This was associated with longer hospitalizations and higher postoperative complication rates. Population-specific ERAS protocols targeted at increasing ERAS completion could reduce morbidity.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Varadhan KK
        • Neal KR
        • Dejong CH
        • Fearon KC
        • Ljungqvist O
        • Lobo DN
        The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials.
        Clin Nutr. 2010; 29 (Epub 2010 Jan 29. PMID: 20116145): 434-440https://doi.org/10.1016/j.clnu.2010.01.004
        • Gustafsson UO
        • Hausel J
        • Thorell A
        • Ljungqvist O
        • Soop M
        • Nygren J
        Enhanced Recovery After Surgery Study Group. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery.
        Arch Surg. 2011; 146 (Epub 2011 Jan 17. PMID: 21242424): 571-577https://doi.org/10.1001/archsurg.2010.309
        • Ren L
        • Zhu D
        • Wei Y
        • Pan X
        • Liang L
        • Xu J
        • et al.
        Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial.
        World J Surg. 2012;; 36 (PMID: 22102090): 407-414https://doi.org/10.1007/s00268-011-1348-4
        • Daneshmand S
        • Ahmadi H
        • Schuckman AK
        • Mitra AP
        • Cai J
        • Miranda G
        • et al.
        Enhanced recovery protocol after radical cystectomy for bladder cancer.
        J Urol. 2014; 192 (Epub 2014 Feb 8. PubMed PMID: 24518775): 50-55https://doi.org/10.1016/j.juro.2014.01.097
        • Tyson MD
        • Chang SS
        Enhanced Recovery Pathways Vs Standard Care After Cystectomy: A Meta-analysis of the Effect on Perioperative Outcomes.
        Eur Urol. 2016; 70 (Epub 2016 Jun 11. Review. PubMed PMID: 27297680; PubMed Central PMCID: PMC5149115): 995-1003https://doi.org/10.1016/j.eururo.2016.05.031
        • Erpelding SG
        • Asral’ Dugan
        • Isharwal S
        • Strup S
        • James A
        • Gupta S
        Cystectomy for benign disease: readmission, morbidity, and complications.
        Can J Urol. 2018; 25 (PubMed PMID: 30281004): 9473-9479
        • Aisen CM
        • Lipsky MJ
        • Tran H
        • Chung DE
        Understanding Simple Cystectomy for Benign Disease: A Unique Patient Cohort With Significant Risks.
        Urology. 2017; 110 (10.1016/j.urology.2017.07.002. Epub 2017 Aug 26. PubMed PMID: 28847690): 239-243
        • Cerantola Y
        • Valerio M
        • Persson B
        • Jichlinski P
        • Ljungqvist O
        • Hubner M
        • et al.
        Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS(®)) society recommendations.
        Clin Nutr. 2013; 32 (Epub 2013 Oct 17. PMID: 24189391): 879-887https://doi.org/10.1016/j.clnu.2013.09.014
        • Gustafsson UO
        • Hausel J
        • Thorell A
        • et al.
        Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery.
        Arch Surg. 2011; 146: 571-577https://doi.org/10.1001/archsurg.2010.309
        • Greco M
        • Capretti G
        • Beretta L
        • Gemma M
        • Pecorelli N
        • Braga M
        Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials.
        World J Surg. 2014; 38 (PMID: 24368573): 1531-1541https://doi.org/10.1007/s00268-013-2416-8
        • McAnally H
        Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol.
        Perioper Med (Lond). 2017; 6 (PMID: 29201359; PMCID: PMC5700757): 19https://doi.org/10.1186/s13741-017-0079-y
        • Angst MS
        • Clark JD
        Opioid-induced hyperalgesia: a qualitative systematic review.
        Anesthesiology. 2006; 104 (PMID: 16508405): 570-587https://doi.org/10.1097/00000542-200603000-00025
        • Anderson PA
        • Subach BR
        • Riew KD
        Predictors of outcome after anterior cervical discectomy and fusion: a multivariate analysis.
        Spine (Phila Pa 1976). 2009; 34 (PMID: 19139666): 161-166https://doi.org/10.1097/BRS.0b013e31819286ea