NEW ORLEANS, LA USA (UroToday.com) - Invasive bladder cancer afflicts elderly patients with multiple comorbidities. Given radical cystectomy (RC) is associated with frequent complications and prolonged recovery after surgery, the authors sought to develop and utilize a peri-operative multidisciplinary algorithm – the Optimized Surgical Journey (OSJ). Developed over the last 18 months, the OSJ attempts to redirect focus from length of stay as a primary endpoint and move towards a series of composite endpoints described in a summative fashion as “poor recovery”. “Poor recovery” is described as inpatient length of stay > 7days or hospital readmission within 30 days.
Retrospective review of 100 patients (50 OSJ, 50 non-OSJ) who underwent RC was reported. Patient characteristics including age, gender, and BMI were similar between the two groups. All non-OSJ patients underwent open RC compared to 28% open RC in the OSJ cohort. Primary study measures included post-surgical recovery, complications, and hospital costs.
OSJ patients showed quicker recovery from surgery with earlier first ambulation, first flatus, first bowel movement, and tolerance of regular diet. Mean length of hospital stay was shorter for patients on the OSJ algorithm. The study authors reported 35% fewer total complications in the OSJ group (95) than in the non-OSJ group (146), and a lower 30-day readmission rate was seen in both groups (not statistically different). Average 90-day cost was nearly 20% lower in the OSJ group.
Wood et al. concluded that the OSJ pathway showed improved recovery after surgery, with fewer complications and lower overall costs at their institutions. This novel treatment paradigm may represent a new recovery endpoint in assessing the delivery of care to RC patients. Future work includes validation of the OSJ algorithm with multicenter patient experience evaluations and comparison to other accelerated recovery pathways.
Presented by Erika L. Wood at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
University of Texas Health Science Center, Houston, TX USA
Reported by Michele Fascelli (University of California-Irvine), medical writer for UroToday.com