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Vol. 64. Issue 6.
Pages 313-322 (June - July 2017)
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Vol. 64. Issue 6.
Pages 313-322 (June - July 2017)
Original article
Impact of an enhanced recovery after surgery programme in radical cystectomy. A cohort-comparative study
Impacto de un programa de recuperación intensificada en cistectomía radical. Estudio comparativo de cohortes
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R. Casans-Francésa,
Corresponding author
rcasans@gmail.com

Corresponding author.
, A.T. Roberto-Alcácerb, A.C. García-Lecinaa, M.L. Ferrer-Ferrera, J. Subirá-Ríosb, J. Guillén-Antóna
a Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Tables (4)
Table 1. Description of the enhanced recovery programme in radical cystectomy applied in our centre.
Table 2. Patient characteristics.
Table 3. Comparison of ERAS vs historical cohort.
Table 4. Hospital stay according overall complications or Clavien–Dindo >2 complications.
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Abstract
Objective

To evaluate the results of the implementation of an enhanced recovery programme (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital.

Material and methods

A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien–Dindo stage >2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared.

Results

No statistically significant differences in overall complication rate were found (73.171 vs. 77.32%; OR 1.25, 95% CI 0.54–2.981; p=0.601) nor in Clavien–Dindo >2 complications (41.463 vs. 42.268%; OR 1.033, 95% CI 0.492–2.167; p=0.93), mortality, lengths of stays readmission and reoperation rates. The need for nasogastric tube insertion was lower in the ERAS group (43.902 vs. 78.351%; OR 4.624, 95% CI 2.112–10.123; p<0.0001), as well as the need for total parenteral nutrition (26.829 vs. 34.021%; OR 12.234, 95% CI 5.165–28.92; p<0.0001), and time under endotracheal intubation since anaesthesia induction (median [IRQ]=325 (285–355) vs. 540 (360–600) min; p<0.0001).

Conclusion

Enhanced recovery programmes in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality.

Keywords:
Cystectomy
Enhanced recovery after surgery
Fast-track surgery
Resumen
Objetivo

Evaluar los resultados de la instauración de un programa de recuperación intensificada (ERAS) para cistectomía radical en abordaje abierto con respecto a la cohorte histórica de un mismo hospital.

Material y métodos

Estudio de análisis retrospectivo de 138 pacientes sometidos a cistectomía radical con derivación ileal tipo Bricker o Studer de forma consecutiva (97 históricos vs. 41 ERAS). Se compararon tasa de complicaciones a 30 días, complicaciones estadio Clavien-Dindo>2, mortalidad, estancia y tasa de readmisión en el hospital y en cuidados críticos, reintervención y necesidad de sondaje nasogástrico, trasfusión o nutrición parenteral.

Resultados

No se hallaron diferencias estadísticamente significativas en cuanto a la tasa de complicaciones globales tras 30 días de alta (73,171 vs. 77.32%; OR 1,25, IC 95% 0,54-2,981; p=0,601) ni en Clavien-Dindo>2 (41,463 vs. 42.268%; OR 1.033, IC 95% 0,492-2,167; p=0,93), así como en mortalidad, estancias o tasas de readmisión y reintervención. La necesidad de sondaje nasogástrico fue menor en el grupo ERAS (43,902 vs. 78,351%; OR 4,624, IC 95% 2,112-10,123; p<0,0001), así como la necesidad de nutrición parenteral total (26,829 vs. 34,021%; OR 12,234, IC 95% 5,165-28,92; p<0,0001) y el tiempo bajo intubación orotraqueal desde la inducción anestésica (mediana [RIC]=325 (285-355) vs. 540 (360-600) min; p<0,0001).

Conclusión

Los programas de recuperación intensificada en cistectomía radical disminuyen el intervencionismo sobre el paciente sin aumentar la morbimortalidad.

Palabras clave:
Cistectomía
Recuperación intensificada tras cirugía
Rehabilitación multimodal

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