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Current application of the enhanced recovery after surgery protocol for patients undergoing radical cystectomy: lessons learned from European excellence centers

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Abstract

Purpose

There is no consensus on which items of Enhanced Recovery After Surgery (ERAS) should and should not be implemented in radical cystectomy (RC). The aim of this study is to report current practices across European high-volume RC centers involved in ERAS.

Methods

Based on the recommendations of the ERAS society, we developed a survey with 17 questions that were validated by the Young Academic Urologists–urothelial group. The survey was distributed to European expert centers that implement ERAS for RC. Only one answer per-center was allowed to keep a representative overview of the different centers.

Results

70 surgeons fulfilled the eligibility criteria. Of note, 28.6% of surgeons do not work with a referent anesthesiologist and 25% have not yet assessed the implementation of ERAS in their center. Avoiding bowel preparation, thromboprophylaxis, and removal of the nasogastric tube were widely implemented (> 90%application). On the other hand, preoperative carbohydrate loading, opioid-sparing anesthesia, and audits were less likely to be applied. Common barriers to ERAS implementation were difficulty in changing habits (55%), followed by a lack of communication across surgeons and anesthesiologist (33%). Responders found that performing a regular audit (14%), opioid-sparing anesthesia (14%) and early mobilization (13%) were the most difficult items to implement.

Conclusion

In this survey, we identified the ERAS items most and less commonly applied. Collaboration with anesthesiologists as well as regular audits remain a challenge for ERAS implementation. These results support the need to uniform ERAS for RC patients and develop strategies to help departments implement ERAS.

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Acknowledgements

EL is supported by the EUSP Scholarship of the European Association of Urology (EAU).

Author information

Authors and Affiliations

  1. Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium

    Simone Albisinni

  2. Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland

    Marco Moschini

  3. Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy

    Ettore Di Trapani

  4. Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy

    Francesco Soria

  5. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy

    Andrea Mari

  6. Department of Urology, München Klinik Bogenhausen, Munich, Germany

    Atiqullah Aziz

  7. S.H.Ho Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong

    Jeremy Teoh

  8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Ekaterina Laukhtina, Keiichiro Mori, David D’Andrea & Benjamin Pradere

  9. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    Ekaterina Laukhtina

  10. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Keiichiro Mori

  11. Department of Urology, La Paz University Hospital, Madrid, Spain

    Diego M. Carrion

  12. Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland

    Wojciech Krajewski

  13. Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan

    Mohammad Abufaraj

  14. Section of Pathological Anatomy, School of Medicine, Marche Polytechnic University, United Hospitals, Ancona, Italy

    Alessia Cimadamore

  15. Division of Surgery and Interventional Science, University College London, London, UK

    Wei Shen Tan

  16. Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France

    Ronan Flippot

  17. Department of Radiotherapy, Institut Claudius Regaud/Institut universitaire du Cancer de Toulouse – Oncopole, Toulouse, France

    Jonathan Khalifa

  18. Department of Anesthesiology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium

    Kimberly Gonsette

Authors
  1. Simone Albisinni
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  2. Marco Moschini
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  3. Ettore Di Trapani
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  4. Francesco Soria
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  5. Andrea Mari
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  6. Atiqullah Aziz
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  7. Jeremy Teoh
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  8. Ekaterina Laukhtina
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  9. Keiichiro Mori
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  10. David D’Andrea
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  11. Diego M. Carrion
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  12. Wojciech Krajewski
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  13. Mohammad Abufaraj
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  14. Alessia Cimadamore
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  15. Wei Shen Tan
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  16. Ronan Flippot
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  17. Jonathan Khalifa
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  18. Kimberly Gonsette
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  19. Benjamin Pradere
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Consortia

the European Association of Urology–Young Academic Urologists Urothelial Carcinoma Working Group (EAU-YAU)

Contributions

Albisinni: project development, Data collection or management, Data analysis, Manuscript writing. Moschini: project development, Manuscript editing. Di Trapani: project development, Data collection or management, Manuscript editing. Soria: project development, Data collection or management, Manuscript editing. Mari: project development, Data collection or management. Aziz: Data collection or management. Jeremy Teoh: project development, Data collection or management. Ekaterina Laukhtina: Data collection or management. Keiichiro Mori: Data collection or management. D’Andrea: project development, Data collection or management, Manuscript editing. Carrion: project development, Data collection or management. Krajewski: project development, Data collection or management. Abufaraj: Data collection or management.

Cimadamore: Data collection or management. Wei Shen Tan: Data collection or management, Manuscript editing. Flippot: Data collection or management. Khalifa Data collection or management. Gonsette: project development. Pradere: project development, Data collection or management, Data analysis, Manuscript editing.

Corresponding author

Correspondence to Simone Albisinni.

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Conflicts of interest

The authors declare no conflict of interest.

Ethics approval

The current research did not involve human or animal participants. The participants in the survey consented to the publishment of the survey’s results.

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Albisinni, S., Moschini, M., Di Trapani, E. et al. Current application of the enhanced recovery after surgery protocol for patients undergoing radical cystectomy: lessons learned from European excellence centers. World J Urol 40, 1317–1323 (2022). https://doi.org/10.1007/s00345-021-03746-x

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  • DOI: https://doi.org/10.1007/s00345-021-03746-x

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