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Improved Outcomes of Enhanced Recovery After Surgery (ERAS) Protocol for Radical Cystectomy with Addition of a Multidisciplinary Care Process in a US Comprehensive Cancer Care Center

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Abstract

Introduction

Although enhanced recovery after surgery (ERAS) components include both anesthesia and surgical care processes, it is unclear whether a multidisciplinary approach to implementing ERAS care processes improves clinical outcomes. The addition of multidisciplinary care with anesthesiology-related components to an existing ERAS protocol for radical cystectomy at a US comprehensive cancer center provided an opportunity to compare short- and long-term outcomes.

Methods

We retrospectively compared the outcomes of 116 consecutive patients who underwent cystectomy after implementation of a multidisciplinary ERAS protocol with those of a historical control group of 143 consecutive patients who had been treated with a surgical ERAS protocol. Length of stay, return of bowel function, rate of blood transfusion, nausea, pain, and readmission rates were examined.

Results

Implementation of a multidisciplinary ERAS protocol was associated with better postsurgical symptom control, as indicated by lower rates of patient-reported nausea (P < .05). Multivariate Poisson regression analysis showed a decrease in estimated intraoperative transfusions (P ≤ .001) after adjusting for the effects of potential confounding variables. There were no statistically significant differences noted in length of stay, return of bowel function, 30- and 90-day complications, or readmissions.

Conclusion

This is the first study to investigate the effects of adding anesthesia ERAS components to an existing surgical ERAS protocol for radical cystectomy. We found that with the addition of anesthesia-related interventions, there was a decrease in transfusions and nausea.

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Acknowledgements

We thank Sonya J. Smyk for editorial support.

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Authors and Affiliations

  1. Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    Sephalie Y. Patel & Rosemarie E. Garcia Getting

  2. Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Scott M. Gilbert, Julio M. Powsang, Wade J. Sexton, Philippe E. Spiess & Michael A. Poch

  3. University of South Florida, Morsani College of Medicine, Tampa, FL, USA

    Brandon Alford & Karim Hussein

  4. Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Braydon J. Schaible, David Boulware & Jae K. Lee

  5. Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Scott M. Gilbert

Authors
  1. Sephalie Y. Patel
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  2. Rosemarie E. Garcia Getting
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  3. Brandon Alford
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  4. Karim Hussein
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  5. Braydon J. Schaible
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  6. David Boulware
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  7. Jae K. Lee
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  8. Scott M. Gilbert
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  9. Julio M. Powsang
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  10. Wade J. Sexton
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  11. Philippe E. Spiess
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  12. Michael A. Poch
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Corresponding author

Correspondence to Sephalie Y. Patel.

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The authors declare no real or potential conflicts of interest.

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Patel, S.Y., Garcia Getting, R.E., Alford, B. et al. Improved Outcomes of Enhanced Recovery After Surgery (ERAS) Protocol for Radical Cystectomy with Addition of a Multidisciplinary Care Process in a US Comprehensive Cancer Care Center. World J Surg 42, 2701–2707 (2018). https://doi.org/10.1007/s00268-018-4665-z

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  • DOI: https://doi.org/10.1007/s00268-018-4665-z

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