Enhanced Recovery for Patients Undergoing Radical Cystectomy. A Randomized Controlled Study

Abstract

Objective: To evaluate the effectiveness of the enhanced recovery protocol versus traditional care on postoperative hospital stay, patients, recovery and complications in patients undergoing radical cystectomy. Background: Despite improvements in surgical technique, anesthesia, and perioperative care, radical cystectomy is still associated with significant morbidity and prolonged hospital stay after surgery more than other urological procedures. Methods: This study included 50 adult patients of both sexes, ASA (American Society of anesthesiology) II-III physical status, aged 40-70 years, scheduled for radical cystectomy. Patients were randomly divided into two equal groups: 25 patients following enhanced recovery protocol after surgery (ERAS group) and 25 patients enrolled in the traditional perioperative care (NON-ERAS group). The length of hospital stay (LOS) was recorded as primary outcome. The onset of bowel movement, early mobilization, duration of postoperative stay care, postoperative opioid consumption, complications, patient’s and surgeon satisfaction were recorded as secondary outcomes. Results: The length of hospital stay was 7.62 ± 0.21 days in ERAS group compared to 12.16 ± 0.39 days in NON-ERAS group. The time to normal diet was 5.28 ± .147 days in ERAS group compared to 8.04 ± .135 days in NON-ERAS group. Enhanced recovery was associated with rapid onset of bowel movement and early fluid and solid diet intake with no significant difference in postoperative complications. Conclusion: In patients undergoing radical cystectomy, enhanced recovery protocol is a safe procedure with no increase in the risk of postoperative complications. The length of stay in hospital and time to full diet are reduced.