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.
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Article info
Publication history
Published online: August 30, 2021
Accepted:
August 19,
2021
Received:
December 5,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
