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Article of the week: Enhanced Recovery Programme for radical cystectomy

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by prominent members of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

If you only have time to read one article this week, it should be this one

Implementation of the Exeter Enhanced Recovery Programme for patients undergoing radical cystectomy

Thomas J. Dutton, Mark O. Daugherty, Robert G. Mason and John S. McGrath

Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK

OBJECTIVES

• To describe our experience with the implementation and refinement of an enhanced recovery programme (ERP) for radical cystectomy (RC) and urinary diversion.

• To assess the impact on length of stay (LOS), complication and readmission rates.

PATIENTS AND METHODS

• In all, 165 consecutive patients undergoing open RC (ORC) and urinary diversion between January 2008 and April 2013 were entered into an ERP.

• A retrospective case note review was undertaken.

• Outcomes recorded included LOS, time to mobilisation, complication rates within the first 30 days (Clavien-Dindo classification) and readmissions.

RESULTS

• All patients were successfully entered into the ERP.

• As enhanced recovery principles became embedded in the unit, LOS reduced from a mean of 14 days over the initial year of the ERP to a mean of 9.2 days.

• The complication rate was 6.6% for Clavien ≥3, and 43.5% for Clavien ≤2. The 30-day mortality rate was 1.2%.

• The 30-day readmission rate was 13.9%.

• In the most contemporary subset of 52 patients: the median time after ORC to sit out of bed, mobilise and open bowels was day 1, 2 and 6, respectively.

CONCLUSIONS

• The ERP described for patients undergoing ORC appears to be safe.

• Benefits include early feeding, mobilisation and hospital discharge.

• The ERP will continue to develop with the incorporation of advancing evidence and technology, in particular the introduction of robot-assisted RC.

 

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