Advertisement

International Journal of Clinical Pharmacy

, Volume 37, Issue 2, pp 379–386 | Cite as

Reduced length of stay in radical cystectomy patients with oral versus parenteral post-operative nutrition protocol

  • Peter DeclercqEmail author
  • Gunter De Win
  • Frank Van der Aa
  • Beels Elodie
  • Lorenz Van der Linden
  • Hendrik Van Poppel
  • Willems Ludo
  • Spriet Isabel
Research Article

Abstract

Background In Europe, parenteral nutrition is often used after radical cystectomy to avoid postoperative malnourishment. To the best of our knowledge, however, there is a paucity of data to conclude on the best modality for delivering nutritional support to this patient group. Objective The parenteral nutrition policy was reconsidered and an oral nutrition protocol was implemented by the clinical pharmacist and evaluated in terms of length of stay, number and type of postoperative complications and parenteral nutrition avoided costs. Setting A prospective interventional non-randomized before-after study was conducted. Regular radical cystectomy patients presenting without preoperative contra-indications for enteral nutrition were eligible. Methods Postoperatively, in the control group, the parenteral nutrition policy from the ward was applied. Parenteral nutrition was initiated systematically and continued until the patient was able to tolerate solid food. In the interventional group, an oral nutrition protocol was implemented. Parenteral nutrition could be initiated if oral intake remained insufficient after 5 days. Main outcome measure The primary end point was postoperative length of stay. Secondary endpoints included the number of patients in whom the oral nutrition protocol was implemented successfully, as well as the number and type of postoperative complications. Results A total of 94 eligible patients was assigned consecutively to the control (n = 48) and to the interventional group (n = 46). Baseline demographics were comparable. A significant reduction in median length of stay was associated with the oral nutrition protocol [18 days (IQR 15–22) in the control group vs. 14 days (IQR 13–18) in the interventional group (p < 0.001)]. In 40 out of 46 patients from the interventional group, the oral nutrition protocol was implemented successfully. The number and type of postoperative complications did not differ significantly. Implementing the oral nutrition protocol resulted in a direct parenteral nutrition infusion bag cost saving of approximately €512 and a reduction in hospitalization cost of €2,608 per patient. Conclusion The findings of our study showed that an oral nutrition protocol, when compared to the systematic postoperative use of parenteral nutrition, was associated with a decreased length of stay and costs in a regular radical cystectomy patient population.

Keywords

Belgium Costs Length of stay Oral nutrition 

Abbreviations

CFU

Colony forming units

CRBSI

Catheter related blood stream infection

EN

Enteral nutrition

ONP

Oral nutrition protocol

POI

Postoperative ileus

POCs

Postoperative complications

PN

Parenteral nutrition

RC

Radical cystectomy

Notes

Funding

None.

Conflicts of interest

The authors declare no conflicts of interest.

References

  1. 1.
    Barrass BJ, Thurairaja R, Collins JW, Gillatt D, Persad RA. Optimal nutrition should improve the outcome and costs of radical cystectomy. Urol Int. 2006;77(2):139–42.CrossRefPubMedGoogle Scholar
  2. 2.
    Hautmann RE, de Petriconi RC, Volkmer BG. 25 years of experience with 1,000 neobladders: long-term complications. J Urol. 2011;185(6):2207–12.CrossRefPubMedGoogle Scholar
  3. 3.
    Svatek RS, Fisher MB, Williams MB, Matin SF, Kamat AM, Grossman HB, et al. Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy. Urology. 2010;76(6):1419–24.CrossRefPubMedGoogle Scholar
  4. 4.
    Adamakis I, Tyritzis SI, Koutalellis G, Tokas T, Stravodimos KG, Mitropoulos D, et al. Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion. Int Braz J Urol. 2011;37(1):42–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Maffezzini M, Campodonico F, Canepa G, Gerbi G, Parodi D. Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus. Surg Oncol. 2008;17(1):41–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Roth B, Birkhauser FD, Zehnder P, Thalmann GN, Huwyler M, Burkhard FC, et al. Parenteral nutrition does not improve postoperative recovery from radical cystectomy: results of a prospective randomised trial. Eur Urol. 2013;63(3):475–82.CrossRefPubMedGoogle Scholar
  7. 7.
    Maffezzini M, Gerbi G, Campodonico F, Parodi D. Multimodal perioperative plan for radical cystectomy and intestinal urinary diversion. I. Effect on recovery of intestinal function and occurrence of complications. Urology. 2007;69(6):1107–11.CrossRefPubMedGoogle Scholar
  8. 8.
    Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28(4):378–86.CrossRefPubMedGoogle Scholar
  9. 9.
    Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg. 2008;12(4):739–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Shrikhande SV, Shetty GS, Singh K, Ingle S. Is early feeding after major gastrointestinal surgery a fashion or an advance? Evidence-based review of literature. J Cancer Res Ther. 2009;5(4):232–9CrossRefPubMedGoogle Scholar
  11. 11.
    Pruthi RS, Chun J, Richman M. Reducing time to oral diet and hospital discharge in patients undergoing radical cystectomy using a perioperative care plan. Urology. 2003;62(4):661–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Joniau S, Benijts J, Van Kampen M, De Waele M, Ooms J, Van Cleynenbreugel B, et al. Clinical experience with the N-shaped ileal neobladder: assessment of complications, voiding patterns, and quality of life in our series of 58 patients. Eur Urol. 2005;47(5):666–72 discussion 72-3.CrossRefPubMedGoogle Scholar
  13. 13.
    Laffey JG, Kavanagh BP. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury. N Engl J Med. 2000;343(11):812.CrossRefPubMedGoogle Scholar
  14. 14.
    Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer. 2004;4:94CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Bohle A, Palou-Redorta J, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Actas Urol Esp. 2012;36(7):389–402.CrossRefPubMedGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Louie-Johnsun MW, Braslis KG, Murphy DL, Neerhut GJ, Grills RJ. Radical cystectomy for primary bladder malignancy: a 10 year review. ANZ J Surg. 2007;77(4):265–9.CrossRefPubMedGoogle Scholar
  19. 19.
    McCabe JE, Jibawi A, Javle P. Defining the minimum hospital case-load to achieve optimum outcomes in radical cystectomy. BJU Int. 2005;96(6):806–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Malavaud B, Vaessen C, Mouzin M, Rischmann P, Sarramon J, Schulman C. Complications for radical cystectomy. Impact of the American Society of Anesthesiologists score. Eur Urol. 2001;39(1):79–84.CrossRefPubMedGoogle Scholar
  21. 21.
    Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55(1):164–74.CrossRefPubMedGoogle Scholar
  22. 22.
    Gregg JR, Cookson MS, Phillips S, Salem S, Chang SS, Clark PE, et al. Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer. J Urol. 2011;185(1):90–6.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Peter Declercq
    • 1
    • 2
    Email author
  • Gunter De Win
    • 3
    • 4
    • 5
  • Frank Van der Aa
    • 3
    • 4
  • Beels Elodie
    • 3
    • 4
  • Lorenz Van der Linden
    • 1
    • 2
  • Hendrik Van Poppel
    • 3
    • 4
  • Willems Ludo
    • 1
    • 2
  • Spriet Isabel
    • 1
    • 2
  1. 1.Pharmacy DepartmentUniversity Hospitals LeuvenLeuvenBelgium
  2. 2.Department of Pharmaceutical and Pharmacological SciencesKU LeuvenLeuvenBelgium
  3. 3.Department of Urology, Faculty of MedicineUniversity Hospitals LeuvenLeuvenBelgium
  4. 4.Department Development and RegenerationKU LeuvenLeuvenBelgium
  5. 5.Department of Urology, Faculty of MedicineUniversity Hospital AntwerpAntwerpBelgium

Personalised recommendations