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90-Day complication rate in patients undergoing radical cystectomy with enhanced recovery protocol: a prospective cohort study

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Abstract

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.

Results

One hundred and sixty-nine cases with a median age of 71 years were included in the study. 90-Day major and minor complication rates were 24.3 and 53.9 %, respectively. The most common complications were infectious and gastrointestinal. The 90-day ER visit rate was 37.9 %, whereas the readmission rate was 29.6 %. The most common cause of hospital readmission and ER visits was infections.

Conclusion

Radical cystectomy and urinary diversion with enhanced recovery protocol is a morbid surgery. The most common complication, cause of ER visit and readmission is yet infections. Further studies on methods to decrease these rates are underway.

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Acknowledgments

We thank our Bladder cancer nursing and support team for all their efforts; Sylvia Rodriguez, Cynthia Cowan, Cortney Montgomery, Sulma Bravo and Clara Horstmeyer as well as our patients.

Author’s contribution

H. Djaladat contributed to the protocol/project development, data collection or management, manuscript writing/editing, critical analysis, supervision; B. Katebian contributed to the protocol/project development, data collection or management, manuscript writing/editing; ST. Bazargani contributed to the data collection or management, manuscript writing/editing, critical analysis; G. Miranda contributed to the data collection or management, data analysis, critical analysis.; J. Cai contributed to the data analysis, critical analysis; AK. Schuckman contributed to the protocol/project development, critical analysis, supervision; and S. Daneshmand contributed to the protocol/project development, manuscript editing, critical analysis, supervision.

Author information

Authors and Affiliations

  1. Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA

    Hooman Djaladat, Soroush T. Bazargani, Gus Miranda, Jie Cai, Anne K. Schuckman & Siamak Daneshmand

  2. USC Institute of Urology, USC School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA

    Behrod Katebian

Authors
  1. Hooman Djaladat
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  2. Behrod Katebian
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  3. Soroush T. Bazargani
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  4. Gus Miranda
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  5. Jie Cai
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  6. Anne K. Schuckman
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  7. Siamak Daneshmand
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Corresponding author

Correspondence to Hooman Djaladat.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendix: USC ERAS protocol for RC and urinary diversion for bladder cancer

Appendix: USC ERAS protocol for RC and urinary diversion for bladder cancer

Preoperative:

  • Precystectomy educational class

  • Carbohydrate loading


  • No bowel preparation

  • Alvimopan


  • No epidural

Intraoperative:

  • Opioid sparing anesthesia


  • Minimize intravenous fluid based on stroke volume/central venous pressure

Postoperative:

  • No nasogastric tube


  • Nausea and vomiting prophylaxis


  • Prokinetics

  • Alvimopan

  • Neostigmine

  • H2 blocker and proton pump inhibitor


  • Early enteral feeding

  • Non-narcotic pain control


  • 24-Hour perioperative antibiotics


  • Home intravenous hydration


  • Prophylactic antibiotics


  • Oral sodium bicarbonate at time of discharge if needed

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Djaladat, H., Katebian, B., Bazargani, S.T. et al. 90-Day complication rate in patients undergoing radical cystectomy with enhanced recovery protocol: a prospective cohort study. World J Urol 35, 907–911 (2017). https://doi.org/10.1007/s00345-016-1950-z

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  • DOI: https://doi.org/10.1007/s00345-016-1950-z

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