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Internal audit of an enhanced recovery after surgery protocol for radical cystectomy

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Abstract

Purpose

To perform an internal audit 5 years after implementation of our enhanced recovery after surgery (ERAS) protocol for patients undergoing radical cystectomy and to investigate the importance of physician driven compliance on outcomes.

Methods

Using a prospectively maintained database, 472 consecutive patients were identified who underwent radical cystectomy with ERAS from July 2013 to July 2017. Compliance was measured by a Composite Compliance Score (CCS) generated as a percentage of 16 interventions. Patients with higher than median compliance were compared to patients with lower compliance. The primary outcome was length of stay. Secondary outcomes included complication and readmission rates. Multivariable regressions were used to control for differences between groups.

Results

In 2013, median CCS was 81% and subsequently ranged from 81 to 88%. Five-year median CCS was 88%. Patients with higher compliance (CCS ≥ 88%, n = 262), as compared to those with lower compliance (CCS < 88%, n = 210), were younger (median 70.3 vs 72.7 years, p = 0.047), healthier (ASA3–4 81% vs 89.9%, p = 0.007), received more orthotopic diversions (59.2% vs 37.6%, p < 0.0001), more often had open surgery (78.5% vs 51.9%, p < 0.0001) and had shorter median operative times (5.5 vs 6.3 h, p = 0.005). Median length of stay was 4 days. Higher compliance was associated with shorter hospital stays (β = − 0.85, 95% CI − 1.62 to − 0.07) and decreased 30-day readmissions (OR 0.58, 95% CI 0.35–0.96).

Conclusions

Greater ERAS compliance was achieved in younger and healthier patients. Patients with greater compliance had a decreased length of stay by almost 1 day and reduced odds of 30-day readmissions.

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Authors and Affiliations

  1. USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA

    Saum Ghodoussipour, Aurash Naser-Tavakolian, Brian Cameron, Anirban P. Mitra, Gus Miranda, Jie Cai, Sumeet Bhanvadia, Monish Aron, Mihir Desai, Inderbir Gill, Anne Schuckman, Siamak Daneshmand & Hooman Djaladat

Authors
  1. Saum Ghodoussipour
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  2. Aurash Naser-Tavakolian
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  3. Brian Cameron
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  4. Anirban P. Mitra
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  5. Gus Miranda
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  6. Jie Cai
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  7. Sumeet Bhanvadia
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  8. Monish Aron
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  9. Mihir Desai
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  10. Inderbir Gill
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  11. Anne Schuckman
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  12. Siamak Daneshmand
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  13. Hooman Djaladat
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Contributions

SG: project development, data collection, data analysis, manuscript writing. AN-T: project development, data collection, data analysis, manuscript writing. BC: data collection, data analysis, manuscript writing. AM: data analysis, manuscript writing. GM: data collection. JC: data analysis. SB: project development. MA: project development. MD: project development. IG: project development. AS: project development. SD: project development, manuscript editing. HD: project development, manuscript editing.

Corresponding author

Correspondence to Saum Ghodoussipour.

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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 (University of Southern California Institutional Review Board (Protocol #HS-01-B0-14) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants.

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Ghodoussipour, S., Naser-Tavakolian, A., Cameron, B. et al. Internal audit of an enhanced recovery after surgery protocol for radical cystectomy. World J Urol 38, 3131–3137 (2020). https://doi.org/10.1007/s00345-020-03135-w

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  • DOI: https://doi.org/10.1007/s00345-020-03135-w

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