Improved Outcomes of Enhanced Recovery After Surgery (ERAS) Protocol for Radical Cystectomy with Addition of a Multidisciplinary Care Process in a US Comprehensive Cancer Care Center.

Authors

Sephalie Y Patel
Rosemarie E Garcia Getting
Brandon Alford
Karim Hussein
Braydon J Schaible
David Boulware
Jae K Lee
Scott M Gilbert
Julio M Powsang
Wade J Sexton
Philippe E Spiess
Michael A Poch

Publication/Presentation Date

9-1-2018

Abstract

INTRODUCTION: Although enhanced recovery after surgery (ERAS) components include both anesthesia and surgical care processes, it is unclear whether a multidisciplinary approach to implementing ERAS care processes improves clinical outcomes. The addition of multidisciplinary care with anesthesiology-related components to an existing ERAS protocol for radical cystectomy at a US comprehensive cancer center provided an opportunity to compare short- and long-term outcomes.

METHODS: We retrospectively compared the outcomes of 116 consecutive patients who underwent cystectomy after implementation of a multidisciplinary ERAS protocol with those of a historical control group of 143 consecutive patients who had been treated with a surgical ERAS protocol. Length of stay, return of bowel function, rate of blood transfusion, nausea, pain, and readmission rates were examined.

RESULTS: Implementation of a multidisciplinary ERAS protocol was associated with better postsurgical symptom control, as indicated by lower rates of patient-reported nausea (P < .05). Multivariate Poisson regression analysis showed a decrease in estimated intraoperative transfusions (P ≤ .001) after adjusting for the effects of potential confounding variables. There were no statistically significant differences noted in length of stay, return of bowel function, 30- and 90-day complications, or readmissions.

CONCLUSION: This is the first study to investigate the effects of adding anesthesia ERAS components to an existing surgical ERAS protocol for radical cystectomy. We found that with the addition of anesthesia-related interventions, there was a decrease in transfusions and nausea.

Volume

42

Issue

9

First Page

2701

Last Page

2707

ISSN

1432-2323

Published In/Presented At

Patel, S. Y., Garcia Getting, R. E., Alford, B., Hussein, K., Schaible, B. J., Boulware, D., Lee, J. K., Gilbert, S. M., Powsang, J. M., Sexton, W. J., Spiess, P. E., & Poch, M. A. (2018). Improved Outcomes of Enhanced Recovery After Surgery (ERAS) Protocol for Radical Cystectomy with Addition of a Multidisciplinary Care Process in a US Comprehensive Cancer Care Center. World journal of surgery, 42(9), 2701–2707. https://doi.org/10.1007/s00268-018-4665-z

Disciplines

Medical Education | Medicine and Health Sciences

PubMedID

29750321

Department(s)

USF-LVHN SELECT Program

Document Type

Article