ERAS Society 2019: Outcomes of Radical Cystectomy Following Implementation of Enhanced Recovery After Surgery Protocols: A Systematic Review
ERAS is an evidence-based approach to perioperative care of the surgical patient. The impact of implementing ERAS protocols on the post-radical cystectomy (RC) complication rate remains largely under-studied. Their objective was to systematically review the literature regarding RC outcomes reporting and the impact of ERAS protocol implementation with respect to RC complications, patient mortality and hospital length of stay.
A systematic review was performed using Ovid MEDLINE® to find research articles published from 1970 through 2018 reporting RC complications according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Randomized, prospective and retrospective studies were screened.
Overall, 4,197 articles were retrieved from electronic databases. Twenty-three (0.6%) studies reported RC outcomes in the context of ERAS and were included in the present systemic review. There were 4 randomized control trials (RCTs) which assessed specific components of ERAS protocols and outcomes following RC. Of the 19 retrospective studies which met inclusion criteria, length of stay followed by 30 and 90-d complications were the most studied primary endpoints following the implementation of ERAS protocols. Only one RC study to date has assessed the impact of all 26 ERAS items (including an audit) on RC outcomes. ERAS resulted in no increased risk of mortality with reduced morbidity, quicker bowel recovery, and shorter length of stay than patients who did not undergo ERAS.
In conclusion, implementation of ERAS protocols was associated with reduced length of hospital stay and post-operative complication rate with no increased risk of mortality. RC outcomes need to be interpreted in the context of ERAS. However, limited studies control for ERAS in RC outcomes data reporting and only one study to date has assessed the impact of all 26 ERAS items (including an audit) on RC outcomes.
Presented and written by: Stephen B. Williams, MD, Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, Texas at the 7th ERAS World Congress, Liverpool, UK, 1-3 May 2019.