Abstract

Objective

To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity.

Materials and methods

We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate.

Results

Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p < 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%, p = 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively, p = 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted [RR = 0.815; 95% confidence interval (CI) 0.667–0.996; p = 0.045]. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications.

Conclusions

Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS

中文翻译：

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一项前瞻性多中心研究的根治性膀胱切除术计划后恢复增强的结果：依从性和成功的关键要素

摘要

目的

调查手术后恢复增强（ERAS）程序对根治性膀胱切除术（RC）后并发症和住院时间（LOS）的影响，并评估ERAS的成分和类型是否在减少手术中起关键作用发病率。

材料和方法

我们分析了11所接受RC的医院中预期招募的277例患者的数据，这些医院最初是根据当地实践管理的（第一类），后来根据ERAS计划进行的（第二类）。定义了两个主要结局：90天并发症发生率和LOS。作为次要变量，我们研究了90天死亡率，30天再入院率和输血率。

结果

第二组患者使用ERAS措施的比例更高（98.6％），高于第一组（78.2％）（p  <0.05）。I组和II组的患者经历了类似的并发症（70.5％比66％，p  = 0.42）。I组和II组之间的​​LOS没有差异（分别为12.5天和14天，p  = 0.59）。采取超过15种ERAS措施的患者发生并发症的风险降低[RR = 0.815; 95％置信区间（CI）0.667-0.996；p  ＝ 0.045]。避免输血和鼻胃管，预防肠梗阻，及早走动和快速摄取常规饮食与无并发症无关。

结论

引入ERAS程序并没有改变RC后的并发症和LOS。我们假设至少应采用15项措施以最大限度地发挥ERAS的优势