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In a recent article by Daneshmand et al. from the University of Southern California, the authors analyzed their early recovery after surgery (ERAS) protocol for patients who underwent radical cystectomy. A total of 110 patients underwent either traditional bowel preparation with no directed pathway versus an ERAS protocol with preoperative counseling, no bowel preparation unless large bowel segment was used for diversion, high-carbohydrate diet day prior to surgery; perioperative limited narcotic requirements with use of Ketorolac and IV Tylenol, Alivopan started 1 hour preoperatively and continued postoperatively, IV fluid monitoring, no nasogastric tube, start oral intake immediately; and postoperative counseling, IV fluids 1 litre every other day, and rigorous follow-up. Median length of stay was significantly lower in the ERAS cohort compared with matched controls (4 vs. 8 days; p < 0.001). 82% of ERAS patients had bowel movement by postoperative day 2, and the 30-day readmission rate was 21% (23 patients). These data support the use of an ERAS protocol to expedite bowel function recovery and shortens hospital stay following radical cystectomy and urinary diversion, with no increased risk for complications or readmissions. These findings are relevant given health care reform initiatives to limit costs and improve quality of care.
Supplementary Articles
1. Karl A, Buchner A, Becker A, et al. A new concept for early recovery after surgery for patients undergoing radical cystectomy for bladder cancer: results of a prospective randomized study. J Urol. 2014;191(2):335– 340.
2. Cerantola Y, Valerio M, Persson B, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: enhanced Recovery After Surgery (ERAS(®)) society recommendations. Clin Nutr. 2013;32(6):879–887.