Initial experiences with the enhanced recovery after surgery (ERAS®) protocol in open radical cystectomy

Abstract

Objective.This article describes the authors’ experiences with the implementation of the Enhanced Recovery After Surgery (ERAS®) protocol for open radical cystectomy (ORC). Adherence to the ERAS cystectomy protocol was assessed; secondary outcome measures were impact on perioperative complication rate (Clavien-Dindo classification), time to first defecation, postoperative length of stay and hospital readmission rate. Materials and methods.This retrospective feasibility study compared outcomes with patients in a historical control group. The study group (ERAS) consisted of 31 consecutive patients undergoing ORC and urinary diversion during 1 year from 1 January to 31 December 2011. The control group (pre-ERAS) comprised 39 consecutive patients operated on during 2010. Follow-up was 30 days. Results.There were no significant demographic differences between the two groups, and no differences in complications graded Clavien III or above, or in total length of stay. The ERAS group had statistically significantly shorter mean time to first passage of stool and statistically significantly lower readmission frequency than the pre-ERAS group. The number of patients was small and the study was not randomized; moreover, the use of historical controls inevitably introduced different types of bias. Conclusions.Introduction of the ERAS protocol is clearly feasible in cystectomy, and may improve clinical outcomes in terms of faster return of bowel function and reduction of readmission within 30 days. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing ORC.

Key Words:

• bladder cancer
• Enhanced Recovery After Surgery (ERAS®)
• open radical cystectomy
• protocol

Declaration of interest: O Ljungqvist owns stock in Encare AB, a commercial company commissioned by the ERAS Society to run the ERAS database and the ERAS implementation program. The authors report no other conflicts of interest. The authors alone are responsible for the content and writing of the paper.