Read by QxMD icon Read

Enhanced recovery cystectomy

Hooman Djaladat, Behrod Katebian, Soroush T Bazargani, Gus Miranda, Jie Cai, Anne K Schuckman, Siamak Daneshmand
PURPOSE: To report 90-day complication rates following radical cystectomy (RC) with enhanced recovery after surgery (ERAS) protocol. METHODS: All consecutive patients who underwent open RC with ERAS protocol from 2012 to 2014 were included. The protocol includes no bowel preparation or NGT, early feeding, predominantly non-narcotic pain management and μ-opioid antagonists. Non-consenting and lost to follow-up patients were excluded. All patients were closely followed up, and 90-day complication (Clavien-Dindo grading), readmission and emergency room (ER) visits were prospectively recorded...
October 12, 2016: World Journal of Urology
Lukas M Löffel, Fiona C Burkhard, Jukka Takala, Patrick Y Wuethrich
BACKGROUND: Gastrointestinal (GI) complications often delay recovery after radical cystectomy with urinary diversion. The authors investigated if perioperative administration of a potassium-enriched, chloride-depleted 5% glucose solution (G5K) accelerates recovery of GI function. METHODS: This randomized, parallel-group, single-center double-blind trial included 44 consecutive patients undergoing radical cystectomy and pelvic lymph node dissection with urinary diversion...
October 2016: Anesthesiology
Christopher M Deibert, Mark V Silva, Arindam RoyChoudhury, James M McKiernan, Douglas S Scherr, David Seres, Mitchell C Benson
OBJECTIVE: To investigate the role of early feeding on recovery after radical cystectomy and urinary diversion. Enhanced recovery protocols have helped to standardize postoperative recovery. This is the first study to directly review the impact of early feeding on recovery in a randomized multi-institutional protocol. METHODS: From 2011 to 2014, patients at 2 large hospitals were randomized after radical cystectomy to receive access to liquids and then a regular diet on postoperative days 1 and 2 or conventional care with introduction of a liquid diet after return of bowel activity, typically days 3-5...
July 8, 2016: Urology
Philip J Cheng, Mark A Preston
No abstract text is available yet for this article.
June 24, 2016: European Urology
Mark D Tyson, Sam S Chang
CONTEXT: Enhanced recovery after surgery (ERAS) protocols aim to improve surgical outcomes by reducing variation in perioperative best practices. However, among published studies, results show a striking variation in the effect of ERAS pathways on perioperative outcomes after cystectomy. OBJECTIVE: To perform a systematic review of the literature and a meta-analysis comparing the effectiveness of ERAS versus standard care on perioperative outcomes after cystectomy...
June 10, 2016: European Urology
Justin W Collins, Hiten Patel, Christofer Adding, Magnus Annerstedt, Prokar Dasgupta, Shamim M Khan, Walter Artibani, Richard Gaston, Thierry Piechaud, James W Catto, Anthony Koupparis, Edward Rowe, Matthew Perry, Rami Issa, John McGrath, John Kelly, Martin Schumacher, Carl Wijburg, Abdullah E Canda, Meviana D Balbay, Karel Decaestecker, Christian Schwentner, Arnulf Stenzl, Sebastian Edeling, Sasa Pokupić, Michael Stockle, Stefan Siemer, Rafael Sanchez-Salas, Xavier Cathelineau, Robin Weston, Mark Johnson, Fredrik D'Hondt, Alexander Mottrie, Abolfazl Hosseini, Peter N Wiklund
CONTEXT: Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC)...
May 24, 2016: European Urology
Bernard J Danna, Erika L Wood, Janet E Baack Kukreja, Jay B Shah
Radical cystectomy (RC) is a complex procedure that can involve long postoperative hospital stays and complicated, burdensome recoveries. Enhanced recovery after surgery is a broad term encompassing an overall approach to perioperative management of postsurgical patients and is becoming more widely accepted for cystectomy patients. This review examines the current evidence for using enhanced recovery protocols for RC as well as current rates of adoption of enhanced recovery among urologists performing RC. We also discuss the next steps for overcoming barriers to the widespread implementation of enhanced recovery for RC...
May 6, 2016: Urology
Janet E Baack Kukreja, Maureen Kiernan, Bethany Schempp, Aisha Siebert, Adriana Hontar, James Dolan, Katia Noyes, Ann Dozier, Ahmed Ghazi, Hani H Rashid, Guan Wu, Edward M Messing
OBJECTIVES: To determine if patients managed with a cystectomy enhanced recovery pathway (CERP) have improved radical cystectomy (RC) quality of care (Quality Improvement in Cystectomy Care with Enhanced Recovery-QUICCER) defined by a decrease in length of stay (LOS) without an increase in complications or readmissions compared to those not managed with CERP. SUBJECTS AND METHODS: QUICCER is a non-randomized quasi-experimental study. Data were collected from June 2011 to April 2015...
April 29, 2016: BJU International
Hooman Djaladat, Siamak Daneshmand
Gastrointestinal (GI) complications are among the most common complications following radical cystectomy and urinary diversion. The most common is postoperative ileus, although its precise pathophysiology is not completely understood. Enhanced recovery after surgery (ERAS) protocols include evidence-based steps to optimize postoperative recovery and shorten hospital stay, mainly through expedited GI function recovery. They include avoiding bowel preparation and postoperative nasogastric tube, early feeding, non-narcotic pain management, and the use of cholinergic and mu-receptor opioid antagonists...
July 2016: Current Urology Reports
Raed A Azhar, Bernard Bochner, James Catto, Alvin C Goh, John Kelly, Hiten D Patel, Raj S Pruthi, George N Thalmann, Mihir Desai
CONTEXT: Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times. OBJECTIVE: To overview the use and key elements of ERAS pathways, and define needs for future clinical trials. EVIDENCE ACQUISITION: A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms "postoperative period," "postoperative care," "enhanced recovery after surgery," "enhanced recovery," "accelerated recovery," "fast track recovery," "recovery program," "recovery pathway", "ERAS," and "urology" or "cystectomy" or "urologic surgery...
July 2016: European Urology
Wei Shen Tan, Benjamin W Lamb, John D Kelly
Radical cystectomy and orthotopic reconstruction significant morbidity and mortality despite advances in minimal invasive and robotic technology. In this review, we will discuss early and late complications, as well as describe efforts to minimize morbidity and mortality, with a focus on ileal orthotopic bladder substitute (OBS). We summarise efforts to minimize morbidity and mortality including enhanced recovery as well as early and late complications seen after radical cystectomy and OBS. Centralisation of complex cancer services in the UK has led to a fall in mortality and high volume institutions have a significantly lower rate of 30-day mortality compared to low volume institutions...
2015: Advances in Urology
Hitendra R H Patel, Pedro Bargão Santos, Manuel Castanheira de Oliveira, Stig Müller
BACKGROUND: Totally intracorporeal robotic-assisted radical cystectomy (RARC) has perceived difficulties compared to open radical cystectomy (ORC). As the technique is increasingly adopted around the world, the benefits of RARC with intra- or extracorporeal urinary diversion or ORC for the patients are still unclear. In this article, we consider the current evidence for this issue. METHODS: We assessed two questions through using expert opinion and the medical literature: (A) Is RARC better than ORC for removing the cancer surgery and outcome? (B) Is RARC better than ORC for the urinary diversion? OUTCOMES: (A) RARC is better than ORC for shorter length of stay, blood loss and complication rates...
January 2016: World Journal of Urology
Janet E Baack Kukreja, Edward M Messing, Jay B Shah
PURPOSE: The concept of enhanced recovery after surgery has been around since the 1990s when it was first introduced as a means to improve postoperative recovery of general surgical patients. In the field of urology, the uptake of enhanced recovery pathways has been slow for unclear reasons. Recently, interest in enhanced recovery after cystectomy (ERAC) has been increasing, but the current urologic oncology practice patterns remain unclear. In this study, we investigate modern perioperative patterns of care and rates of application of ERAC principles by cystectomy surgeons...
March 2016: Urologic Oncology
Hamed Ahmadi, Cheryl T Lee
PURPOSE OF REVIEW: Patients who undergo radical cystectomy and urinary diversion experience a lengthy period of postoperative recovery from physical, functional, social, and emotional challenges that greatly impact health-related quality of life (HRQoL). These changes affect nearly all patients and must be reviewed in detail as part of the preoperative consultation. However, quantifying a patient's risk for altered HRQoL is imprecise, thus complicating the choice for urinary diversion...
November 2015: Current Opinion in Urology
C W Lai, T Starkie, S Creanor, R A Struthers, D Portch, P D Erasmus, N Mellor, K B Hosie, J R Sneyd, G Minto
BACKGROUND: The benefits of stroke volume optimization during surgery are unclear, with recent data not replicating the positive effects of earlier studies. METHODS: This was a randomized controlled trial of standard fluid therapy with or without supplementary blinded intraoperative stroke volume optimization in 220 patients having major elective rectal resection or cystectomy with ileal conduit. All patients were treated using a contemporary enhanced recovery pathway...
October 2015: British Journal of Anaesthesia
Richard S Matulewicz, Jeffrey Brennan, Raj S Pruthi, Shilajit D Kundu, Chris M Gonzalez, Joshua J Meeks
OBJECTIVE: To present an evidence-based review of the perioperative management of the radical cystectomy (RC) patient in the context of a care redesign initiative. METHODS: A comprehensive review of the key factors associated with perioperative management of the RC patient was completed. PubMed, Medline, and the Cochrane databases were queried via a computerized search. Specific topics were reviewed within the scope of the three major phases of perioperative management: preoperative, intraoperative, and postoperative...
December 2015: Urology
Justin W Collins, Christofer Adding, Abolfazl Hosseini, Tommy Nyberg, Giovannalberto Pini, Linda Dey, Peter N Wiklund
OBJECTIVE: The aim of this study was to assess the effect of introducing an enhanced recovery programme (ERP) to an established robot-assisted radical cystectomy (RARC) service. MATERIALS AND METHODS: Data were prospectively collected on 221 consecutive patients undergoing totally intracorporeal RARC between December 2003 and May 2014. The ERP was specifically designed to support an evolving RARC service, where increasing proportions of patients requiring radical cystectomy underwent RARC...
2016: Scandinavian Journal of Urology
Domenic Di Rollo, Aza Mohammed, Alexander Rawlinson, Jayne Douglas-Moore, John Beatty
INTRODUCTION: The principles of enhanced recovery after surgery (ERAS) protocols have been developed to optimize care and facilitate recovery after major surgery. The purpose of this systematic review is to present an up-to-date assessment of the perioperative cares in complex urological surgery from the available evidence and ERAS group recommendations. MATERIALS AND METHODS: Systematic searches of PubMed, Embase, Cochrane library and conference abstracts and bibliographies databases...
June 2015: Canadian Journal of Urology
Weichen Xu, Siamak Daneshmand, Soroush T Bazargani, Jie Cai, Gus Miranda, Anne K Schuckman, Hooman Djaladat
PURPOSE: Opioids have traditionally been the mainstay of pain management after radical cystectomy for bladder cancer but they have many side effects. The efficacy of opioid sparing analgesics after cystectomy as part of a protocol of enhanced recovery after surgery has yet to be proved. We compared opioid use, pain score and postoperative ileus in consecutive patients on a protocol of enhanced recovery after surgery and those on a traditional protocol after radical cystectomy. MATERIALS AND METHODS: Using our institutional review board approved bladder cancer database we retrospectively reviewed the records of patients who underwent open radical cystectomy using a traditional protocol or a protocol of enhanced recovery after surgery for pain management...
November 2015: Journal of Urology
Anthony Koupparis, Christian Villeda-Sandoval, Nicola Weale, Motaz El-Mahdy, David Gillatt, Edward Rowe
OBJECTIVES: To assess the impact of the introduction of robot-assisted radical cystectomy (RARC) on an established enhanced recovery programme (ERP) and to examine the effect on mortality and morbidity rates, transfusion rates, and length of stay (LOS). PATIENTS AND METHODS: Data on 102 consecutive patients undergoing RARC with full intracorporeal reconstruction were obtained from our prospectively updated institutional database. These data were compared to previously published retrospective results from three separate groups of patients undergoing open radical cystectomy (ORC) at our centre...
December 2015: BJU International
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"