Open AccessImproved 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
Author(s) -
Patel Sephalie Y.,
Garcia Getting Rosemarie E.,
Alford Brandon,
Hussein Karim,
Schaible Braydon J.,
Boulware David,
Lee Jae K.,
Gilbert Scott M.,
Powsang Julio M.,
Sexton Wade J.,
Spiess Philippe E.,
Poch Michael A.
Publication year - 2018
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-018-4665-z
Subject(s) - cystectomy , medicine , nausea , anesthesiology , bladder cancer , poisson regression , multidisciplinary approach , cardiothoracic surgery , vascular surgery , perioperative , surgery , cancer , emergency medicine , anesthesia , cardiac surgery , population , social science , environmental health , sociology
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.