Per Bagi1*, Peter Thind1, Lisbeth Salling1, Martin Skønnemand2 Susann Vellier Hansen1 and Henrik Kehlet3
1Department of Urology, Copenhagen University, Denmark
2Department of Anestesiology, Copenhagen University, Denmark
3Department of Surgical Pathophysiology, Copenhagen University, Denmark
Introduction: Enhanced Recovery After Surgery (ERAS) has consistently led to decreased need for hospitalisation and risk of complications without increased readmission rates. ERAS has recently spread to Radical Cystectomy (RC), but so far with limited data.Methods: We introduced an aggressive ERAS program for RC as one step. The results from two cohorts, each consisting of 25 consecutive patients undergoing RC before and after introducing our ERAS program were compared. The ERAS program focused on preoperative education of patient and intra-/postoperative care, with normovolemia, accelerating mobilization and removal of gastric tube facilitating early oral feeding. Analgesia was secured by local anaesthesia, avoiding epidural, and low dose opioid, combined non-opioid analgesics and antiemetics, including highdose preoperative methylprednisolone.LOS was reduced from 7 to 4 days, and positive fluid balance and duration of nasogastric suction were reduced (p <0.05) after introducing ERAS. In-hospital rate of serious complications (Clavien- Dindo grade above 2) was 6%, similar in both groups. After 90 days, 1 patient had died, and further 14 patients (28%) suffered serious complications. Readmission occurred in 22 patients (44%), but one third required no or minor non-surgical intervention, similar in both groups. There was no difference in outcomes between open vs. robot-assisted RC.Conclusions: Introduction of an aggressive RC ERAS program reduced LOS to about 4 days without increasing morbidity or readmissions, calling for future large-scale safety studies.
Bagi P, Thind P, Salling L, Skønnemand M, Vellier Hansen S, Kehlet H. Feasibility of a Fast-Track Cystectomy Program. Clin Oncol. 2017; 2: 1243.