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ERAS cystectomy

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https://www.readbyqxmd.com/read/29032237/hospital-charges-and-length-of-stay-following-radical-cystectomy-in-the-eras-era
#1
Alice Semerjian, Niv Milbar, Max Kates, Michael A Gorin, Hiten D Patel, Heather J Chalfin, Steven M Frank, Christopher L Wu, William W Yang, Deb Hobson, Lindsay Robertson, Elizabeth Wick, Mark P Schoenberg, Phillip M Pierorazio, Michael H Johnson, C J Stimson, Trinity J Bivalacqua
OBJECTIVE: To report our center's experience with Enhanced Recovery after Surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease length of stay (LOS) and post-operative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns. MATERIALS AND METHODS: Our ERAS protocol was implemented for RC in December 2015...
October 12, 2017: Urology
https://www.readbyqxmd.com/read/28976345/-impact-of-a-goal-directed-therapy-in-the-implementation-of-an-eras-enhanced-recovery-after-surgery-protocol-in-laparoscopic-radical-cystectomy
#2
Rafael Uña Orejón, Ivan Huercio Martinez, Estrella Mateo Torres, Cristina Jofré Escudero, Juan Gomez Rivas, Jesús Diez Sebastián, Maria Prado Ureta Tolsada
OBJECTIVES: The intraoperative goaldirected fluid therapy (GDT) has become the base of perioperative management in the fast-track protocols. This program using technology to estimate cardiac output, with the aim of minimizing splanchnic hypoperfusion. However, there is insufficient evidence to confirm its application in radical laparoscopic cystectomy. METHODS: In a retrospective study, we have included 52 patients that were scheduled for radical cystectomy. In group A (n=32) patients were treated following GDT...
October 2017: Archivos Españoles de Urología
https://www.readbyqxmd.com/read/28940448/enhanced-recovery-after-urologic-surgery-current-applications-and-future-directions
#3
REVIEW
Daniel Zainfeld, Hooman Djaladat
Coordinated multidisciplinary perioperative care through enhanced recovery protocols has improved outcomes within urologic surgery. Continued development and refinement of enhanced recovery after surgery (ERAS) pathways will further augment the care of patients undergoing all urologic procedures. Among the challenges, moving forward is identification of barriers to ERAS adoption by providers, maximizing adherence among patients, standardization of ERAS pathways through establishment of evidence-based principles, and application in additional complex urologic procedures beyond radical cystectomy...
September 22, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28801217/evaluation-of-unplanned-hospital-readmissions-after-major-urologic-inpatient-surgery-in-the-era-of-accountable-care
#4
Benjamin V Stone, Matthew R Cohn, Nicholas M Donin, Michael Schulster, James S Wysock, Danil V Makarov, Marc A Bjurlin
OBJECTIVE: To provide a multi-institutional analysis of clinical factors predicting unplanned hospital readmission after major inpatient urologic surgery. MATERIALS AND METHODS: The American College of Surgeons National Surgical Quality Improvement Program is a risk-adjusted data collection mechanism for analyzing clinical outcomes data including 30-day perioperative readmissions and complications. We identified 23,108 patients who underwent major inpatient urologic surgery from 2011 to 2012...
August 8, 2017: Urology
https://www.readbyqxmd.com/read/28801130/prospective-implementation-of-enhanced-recovery-after-surgery-protocols-to-radical-cystectomy
#5
Karl H Pang, Ruth Groves, Suresh Venugopal, Aidan P Noon, James W F Catto
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...
August 8, 2017: European Urology
https://www.readbyqxmd.com/read/28753885/gastrointestinal-complications-following-radical-cystectomy-using-enhanced-recovery-protocol
#6
Soroush T Bazargani, Hooman Djaladat, Hamed Ahmadi, Gus Miranda, Jie Cai, Anne K Schuckman, Siamak Daneshmand
BACKGROUND: The development of enhanced recovery after surgery (ERAS) protocols for patients undergoing radical cystectomy (RC) represents a significant advance in perioperative care. OBJECTIVE: To evaluate gastrointestinal (GI) complications following RC and urinary diversion (UD) using our institutional ERAS protocol. DESIGN, SETTING, AND PARTICIPANTS: We identified 377 consecutive cases of open RC and UD for which our ERAS protocol was used from May 2012 to December 2015...
April 25, 2017: European Urology Focus
https://www.readbyqxmd.com/read/28587844/postoperative-management-of-radical-cystectomy-review-of-the-evidence-on-the-prevention-and-treatment-of-urological-complications
#7
O Rodríguez Faba, R Parada Moreno, L Malca, A Palomino Martínez, N Nervo, A Breda, C Esquinas, J Palou
INTRODUCTION AND OBJECTIVES: This review article focuses on the prevention and management of the most common postoperative urological complications of radical cystectomy. We reviewed the current literature and conducted an analysis of frequency, prevention and treatment of complications. ACQUISITION OF EVIDENCE: We conducted a search on Medline to identify original articles, literature reviews and editorials focusing on the urological complications of radical cystectomy during the first 90 days after surgery...
June 3, 2017: Actas Urologicas Españolas
https://www.readbyqxmd.com/read/28476526/restrictive-transfusion-in-radical-cystectomy-is-safe
#8
Sumeet Syan-Bhanvadia, Siri Drangsholt, Swar Shah, Jie Cai, Gus Miranda, Hooman Djaladat, Siamak Daneshmand
INTRODUCTION AND OBJECTIVE: Perioperative blood transfusion (PBT) is commonplace in radical cystectomy (RC) and has been linked to poorer oncologic outcomes. Limiting PBT in this largely elderly and comorbid population has not been studied. Herein, we first investigate the safety of a restrictive transfusion protocol (RTP) in patients undergoing RC for urothelial carcinoma and then compare oncologic outcomes between patients who did and did not receive PBT. METHODS: Outcomes for 173 consecutive patients meeting inclusion criteria undergoing RC for urothelial carcinoma from April 2010 to June 2014 by a single surgeon employing RTP were analyzed from an institutional review board-approved, prospectively collected database...
May 2, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/28342928/does-implementing-an-enhanced-recovery-after-surgery-protocol-increase-hospital-charges-comparisons-from-a-radical-cystectomy-program-at-a-specialty-cancer-center
#9
Juan Chipollini, Dominic H Tang, Karim Hussein, Sephalie Y Patel, Rosemarie E Garcia-Getting, Julio M Pow-Sang, Scott M Gilbert, Wade J Sexton, Philippe E Spiess, Michael A Poch
OBJECTIVE: To compare perioperative charges induced at the initial phase of a standardized enhanced recovery after surgery (ERAS) program from a tertiary referral center. METHODS: A multidisciplinary ERAS protocol was implemented in our department on July 2015. During the subsequent year, all patients were treated according to this protocol (ERAS group). The patients were compared in terms of real in-hospital charges per surgical episode with a control group consisting of consecutive patients before the start of ERAS...
March 23, 2017: Urology
https://www.readbyqxmd.com/read/28214097/impact-of-an-enhanced-recovery-after-surgery-programme-in-radical-cystectomy-a-cohort-comparative-study
#10
R Casans-Francés, A T Roberto-Alcácer, A C García-Lecina, M L Ferrer-Ferrer, J Subirá-Ríos, J Guillén-Antón
OBJECTIVE: To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital. MATERIAL AND METHODS: A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared...
June 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28149935/readmission-rate-and-causes-at-90-day-after-radical-cystectomy-in-patients-on-early-recovery-after-surgery-protocol
#11
Emanuela Altobelli, Maurizio Buscarini, Harcharan S Gill, Eila C Skinner
Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014...
January 27, 2017: Bladder Cancer
https://www.readbyqxmd.com/read/28013038/potential-implications-of-shortening-length-of-stay-following-radical-cystectomy-in-a-pre-eras-population
#12
Takahiro Osawa, Sapan N Ambani, Kola Olugbade, Ted A Skolarus, Alon Z Weizer, Jeffrey S Montgomery, Chang He, Khaled S Hafez, Brent K Hollenbeck, Cheryl T Lee, James E Montie, Ganesh S Palapattu, Todd M Morgan
OBJECTIVE: To investigate whether shortened inpatient length of stay (LOS) after radical cystectomy (RC) is associated with increased complication rates after hospital discharge. MATERIALS AND METHODS: The analytic cohort comprised 484 consecutive patients with 90-day follow-up who underwent RC at our institution from 2005 to 2012 and with LOS ≤9 days. Patients were categorized according to LOS as short (s-LOS; ≤5 days) or routine (r-LOS; 6-9 days). The primary outcome was major complications (Clavien-Dindo grades 3-5) occurring within 90 days after discharge...
December 21, 2016: Urology
https://www.readbyqxmd.com/read/28008756/cost-effectiveness-and-robot-assisted-urologic-surgery-does-it-make-dollars-and-sense
#13
Ryan W Dobbs, Brenden P Magnan, Nikita Abhyankar, Ashok K Hemal, Ben Challacombe, Jim Hu, Prokar Dasgupta, Francesco Porpiglia, Simone Crivellaro
INTRODUCTION: The introduction of the robotic surgical platform has led to distinct changes in practice patterns and the utilization of minimally invasive surgery in urology. While use of the robotic system is associated with improvements in perioperative outcomes such as estimated blood loss and hospital stay, there are significant fixed and variable costs with the purchase, maintenance and use of the robotics system that has led many authors to investigate the cost effectiveness of robotic urologic surgery...
December 22, 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
https://www.readbyqxmd.com/read/27738804/sentinel-node-detection-in-muscle-invasive-urothelial-bladder-cancer-is-feasible-after-neoadjuvant-chemotherapy-in-all-pt-stages-a-prospective-multicenter-report
#14
Robert Rosenblatt, Markus Johansson, Farhood Alamdari, Alexander Sidiki, Benny Holmström, Johan Hansson, Janos Vasko, Per Marits, Susanne Gabrielsson, Katrine Riklund, Ola Winqvist, Amir Sherif
PURPOSE: To determine whether sentinel node detection (SNd) in muscle-invasive urothelial bladder cancer (MIBC) can be performed in patients undergoing neoadjuvant chemotherapy (NAC) and determine whether SNd is feasible in all pT stages, including pT0. BACKGROUND: Previous published series of SNd in MIBC have not included patients undergoing NAC, and systematic reports of pT0 patients w/wo NAC were absent. Translational immunological tumor research on MIBC focusing on SNd, in the era of NAC, requires technical feasibility...
June 2017: World Journal of Urology
https://www.readbyqxmd.com/read/27734131/90-day-complication-rate-in-patients-undergoing-radical-cystectomy-with-enhanced-recovery-protocol-a-prospective-cohort-study
#15
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...
June 2017: World Journal of Urology
https://www.readbyqxmd.com/read/27476163/redefining-the-implications-of-nasogastric-tube-placement-following-radical-cystectomy-in-the-alvimopan-era
#16
Vignesh T Packiam, Vijay A Agrawal, Joseph J Pariser, Andrew J Cohen, Charles U Nottingham, Shane M Pearce, Norm D Smith, Gary D Steinberg
PURPOSE: Alvimopan has decreased ileus and need for nasogastric tube (NGT) after radical cystectomy (RC). However, the natural history of ileus versus intestinal obstruction in patients receiving alvimopan is not well defined. We sought to examine the implications of NGT placement before and after the introduction of alvimopan for RC patients. METHODS: Retrospective review identified 278 and 293 consecutive patients who underwent RC before and after instituting alvimopan between June 2009 and May 2014...
April 2017: World Journal of Urology
https://www.readbyqxmd.com/read/27297680/enhanced-recovery-pathways-versus-standard-care-after-cystectomy-a-meta-analysis-of-the-effect-on-perioperative-outcomes
#17
REVIEW
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...
December 2016: European Urology
https://www.readbyqxmd.com/read/27164287/the-future-of-enhanced-recovery-for-radical-cystectomy-current-evidence-barriers-to-adoption-and-the-next-steps
#18
REVIEW
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...
October 2016: Urology
https://www.readbyqxmd.com/read/27125653/gastrointestinal-complications-in-patients-who-undergo-radical-cystectomy-with-enhanced-recovery-protocol
#19
REVIEW
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
https://www.readbyqxmd.com/read/26970912/enhanced-recovery-after-urological-surgery-a-contemporary-systematic-review-of-outcomes-key-elements-and-research-needs
#20
REVIEW
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
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