MP47-13 ROBOT-ASSISTED RADICAL CYSTECTOMY IN OCTOGENARIANS AND THE EFFECT OF AN ENHANCED RECOVERY PATHWAY ON PERI-OPERATIVE INDICES

METHODS: Patients undergoing open radical cystectomy (ORC) and robotic assisted radical cystectomy (RARC) and urinary diversion with ERAS for bladder urothelial carcinoma from May 2012 to December 2016 were studied. Surgical and clinical outcomes within 90 days after surgery were compared between ORC and RARC, including LOS, readmission and major complication rates (Clavien-Dindo grade 3). Multivariable logistic regression modeling was used to determine factors that predict extended LOS (>4 days), readmission and major complications. RESULTS: A total of 345 and 143 patients underwent ORC and RARC, respectively. The ORC group had a greater proportion of continent urinary diversion (71.9 vs 40.6%, p<0.001), shorter operative time (5.4 vs 7.3 h, p<0.001), higher estimated blood loss (500 vs 200 ml, p<0.001), and higher intraoperative and postoperative transfusion rates (20.9 vs 9.1%, p1⁄40.002 and 20 vs 11.9%, p1⁄40.04, respectively). Median LOS was 4 days for ORC (IQR 4-6 days) and 6 days for RARC (IQR 4-7 days) (p<0.001). There was no significant difference in readmission rates or major complication rates within 30 and 90 days after surgery. Patients with extended LOS had older age (73 vs 68, p<0.001), more comorbidities (p<0.001), longer operative time (6.3 vs 5.6 h, p<0.001), higher intraoperative and postoperative transfusion rate (24 vs 9.5%, p<0.001 and 22.5 vs 11.8%, p1⁄40.002, respectively). Patients who were readmitted within 90 days had older age (73 vs 70, p1⁄40.007), greater proportion of diabetes (32.7 vs 17.5%, p<0.001), and higher transfusion rate (42 vs 24.5%, p<0.001). Patients having major complications had older age (73 vs 70, p1⁄40.01), lower baseline of hemoglobin (11.5 vs 12.2 g/dL, p1⁄40.05) and hematocrit (36 vs 36.8, p1⁄40.04), and higher transfusion rates (41.2 vs 27.5%, p1⁄40.01). Multivariable logistic regression analysis showed that surgical approach was not an independent factor predictive of extended LOS, readmission or major complications. CONCLUSIONS: In the framework of an ERAS protocol, surgical approach was not a determinate factor of clinical outcomes of RC. The evidence-based ERAS protocol is the key factor for optimal patient recovery.