San Diego, CA USA (UroToday.com) Dr. Gregory Diorio presented a study evaluating the Benefits of a Multidisciplinary Approach to Enhanced Recovery after Surgery and Radical Cystectomy. Despite advances in operative care the morbidity of radical cystectomy (RC) remains high. It is widely known that Enhanced Recovery after Surgery (ERAS) decrease systemic stress response, optimize pain control and reduce hospital stays.
Past protocols have focused heavily on post-operative ERAS components. In a multidisciplinary effort to expand ERAS at our institution, we standardized intraoperative ERAS components emphasizing perioperative anesthesia interventions. They reported initial results of an expanded multidisciplinary ERAS (mdERAS) protocol in this study.
The authors report their initial results of an expanded multidisciplinary ERAS (mdERAS) protocol in this study. The Records of patients treated with RC from May 2014-Sept 2015 were reviewed. The standard ERAS (sERAS) protocol the authors describe consisted of alvimopan, acetaminophen, DVT prophylaxis, thoracic epidural (in selected cases), omission of nasogastric tubes, early resumption of oral nutrition and minimizing narcotics.
From August 2015, The mdERAS protocol, consisted of sERAS plus preoperative gabapentin, oral hydration 2 hours prior to induction, and intraoperative goal directed fluid therapy. Mechanical bowel prep was not administered. Clinical variables including age, ASA class, pT stage, epidural, diversion type, EBL, intraoperative crystalloid, albumin and volume PRBC transfused were compared between groups.
Primary outcomes were time to first flatus (TFF) and length of stay (LOS). Independent variables were compared using Welch's t-test and the correlation between outcomes was performed using the Spearman correlation coefficient. The mdERAS group consisted of 24 patients and there were 157 patients in the sERAS group. Demographics between the two groups were similar.
No difference was seen between the two groups in terms of TFF. LOS was shorter in the mdERAS group by 1 day. Same results were obtained even if an epidural was not administered. The authors conclude that a multidisciplinary approach to ERAS for RC can translate into shorter LOS. Preoperative oral hydration and intraoperative goal directed fluid therapy in conjunction with standard ERAS components may be additional keys to optimizing RC outcomes.
Presented By: Gregory Diorio, MD.
Written By: Miki Haifler MD. Fox Chase Cancer Center, Philadelphia, PA. at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA