BACKGROUND Multimodal enhanced recovery after surgery (ERAS) regimens have improved outcomes from colorectal surgery. OBJECTIVE We report the application of ERAS to patients undergoing radical cystectomy (RC). DESIGN, SETTING, AND PARTICIPANTS Prospective collection of outcomes from consecutive patients undergoing RC at a single institution. INTERVENTION Twenty-six components including prehabilitation exercise, same day admission, carbohydrate fluid loading, targeted intraoperative fluid resuscitation, regional local anaesthesia, cessation of nasogastric tubes, omitting oral bowel preparation, avoiding drain use, early mobilisation, chewing gum use, and audit. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcomes were length of stay and readmission rate. Secondary outcomes included intraoperative blood loss, transfusion rates, survival, and histopathological findings. RESULTS AND LIMITATIONS Four hundred and fifty-three consecutive patients underwent RC, including 393 (87%) with ERAS. Length of stay was shorter with ERAS (median [interquartile range]: 8 [6-13] d) than without (18 [13-25], p<0.001). Patients with ERAS had lower blood loss (ERAS: 600 [383-969] ml vs 1050 [900-1575] ml for non-ERAS, p<0.001), lower transfusion rates (ERAS: 8.1% vs 25%, chi-square test, p<0.001), and fewer readmissions (ERAS: 15% vs 25%, chi-square test, p=0.04) than those without. Histopathological parameters (eg, tumour stage, node count, and margin state) and survival outcomes did not differ with ERAS use (all p>0.1). Multivariable analysis revealed ERAS use was (p=0.002) independently associated with length of stay. CONCLUSIONS The use of ERAS pathways was associated with lower intraoperative blood loss and faster discharge for patients undergoing RC. These changes did not increase readmission rates or alter oncological outcomes. PATIENT SUMMARY Recovery after major bladder surgery can be improved by using enhanced recovery pathways. Patients managed by these pathways have shorter length of stays, lower blood loss, and lower transfusion rates. Their adoption should be encouraged.

中文翻译：

---

根治性膀胱切除术术后加速恢复方案的前瞻性实施。

背景 多模式加速术后恢复 (ERAS) 方案改善了结直肠手术的结果。目的 我们报告 ERAS 在接受根治性膀胱切除术 (RC) 的患者中的应用。设计、设置和参与者 前瞻性收集在单个机构接受 RC 的连续患者的结果。干预 26 个组成部分，包括康复训练、当天入院、碳水化合物补液、有针对性的术中液体复苏、局部局部麻醉、停止鼻胃管、省略口腔肠道准备、避免使用引流管、早期活动、口香糖使用和审核。结果测量和统计分析 主要结果是住院时间和再入院率。次要结局包括术中失血、输血率、存活率和组织病理学检查结果。结果和局限性 453 名连续患者接受了 RC，其中 393 名 (87%) 患有 ERAS。使用 ERAS 的住院时间（中位数 [四分位距]：8 [6-13] d）比没有使用的时间短（18 [13-25]，p<0.001）。ERAS 患者的失血量较低（ERAS：600 [383-969] ml vs 1050 [900-1575] ml，非 ERAS，p<0.001），输血率较低（ERAS：8.1% vs 25%，卡方检验，p<0.001），再入院率（ERAS：15% vs 25%，卡方检验，p=0.04）比没有的人少。使用 ERAS 的组织病理学参数（例如，肿瘤分期、淋巴结计数和边缘状态）和生存结果没有差异（所有 p>0.1）。多变量分析显示 ERAS 的使用与住院时间独立相关（p=0.002）。结论 ERAS 通路的使用与接受 RC 的患者术中失血量减少和出院更快有关。这些变化并没有增加再入院率或改变肿瘤学结果。患者总结 大膀胱手术后的恢复可以通过使用增强的恢复途径得到改善。通过这些途径管理的患者住院时间更短，失血更少，输血率更低。应鼓励采用它们。