[21] Implementation of an enhanced recovery after surgery (ERAS) protocol for radical cystectomy: a Moroccan single-centre experience

Objective

To evaluate the impact of the implementation of an enhanced recovery after surgery (ERAS) protocol on functional results after radical cystectomy (RC) for bladder cancer, as RC is a major surgery with significant morbidity and mortality risks.

Methods

We conducted a monocentric prospective study from March 2017 to April 2018. Patients who underwent RC for bladder cancer at our institute after introduction of the ERAS protocol were compared with a control group of patients who previously underwent surgery with a standard protocol (control group). Primary endpoints evaluated were: length of hospital stay, rates of complications, gas recovery time, and first defaecation. The comparison of the means was performed using the Student’s test for quantitative variables, and the Pearson chi-square test and the Fisher’s test for the qualitative variables; statistical significance was considered at a P < 0.05.

Results

We studied 45 consecutive patients, 17 operated upon with the traditional protocol and 27 according to the ERAS protocol. The mean hospital stay was 9.4 vs 11.7 days, in favour of the ERAS group (P = 0.05). The gas recovery time was longer in the control group, at 69.8 vs 36.4 h (P < 0.001). The delay of the first defaecation was less in the ERAS group, at 126.6 vs 64.6 h (P < 0.001). The general postoperative complication rate was 31% in the control group and 24.4% in the ERAS group. The rate of gastrointestinal complications was higher in the control group, at 8.8% vs 2.2%.

Conclusion

Despite the heterogeneity in ERAS protocols, which are different from one centre to another, its application significantly reduced the length of hospital stay and tended to reduce the rate of general and gastrointestinal complications, and the time to gas recovery and first defaecation.