title: Fast track surgery to reduce short-term complications following radical cystectomy and intestinal urinary diversion with Vescica Ileale Padovana neobladder: proposal for a tailored enhanced recovery protocol and preliminary report from a pilot study.
abstract: OBJECTIVE
  Different fast track programs for patients undergoing radical cystectomy (RC) can be found in the current literature. The aim of this work was to develop a new enhanced recovery protocol (ERP).
  
  
  METHODS
  The ERP was designed after a structured literature review focusing on reduced bowel preparation, standardized feeding, postoperative nausea, vomiting and pain control. In order to test the ERP, a pilot observational prospective cohort study was planned, enrolling all patients consecutively undergoing RC and Vescica Ileale Padovana (VIP) neobladder. These patients were compared with a matched group of subjects who had undergone RC and VIP neobladder before implementation of the ERP. To achieve good comparability, a propensity score-matching was performed. The primary aim was to assess the ERP's feasibility; the secondary outcome measures were early morbidity and mortality.
  
  
  CONCLUSIONS
  After an exhaustive literature search and a multidisciplinary consultation, an ERP was designed. Nine consecutive patients participated in the pilot study and were compared to 13 patients treated before implementation of the ERP. We did not find any statistically significant difference in terms of mortality rate (none died peri- or postoperatively in both groups). The complication rate, according to the modified Clavien classification, was significantly lower in the ERP group (22.22 vs. 84.61%, p < 0.004). The major limitations are the low number of patients enrolled to test the protocol and the lack of randomization for the comparative evaluations.
  
  
  CONCLUSIONS
  The introduction of our ERP was proven to be feasible in the management of patients undergoing RC and intestinal urinary diversion with VIP neobladder. The postoperative course was enhanced by a significant reduction in both nasogastric tube insertion and parenteral nutrition support, with early postoperative feeding. All these findings were associated with no deleterious effect on morbidity or mortality, indeed there was a reduced occurrence of postoperative complication rates.
authors.affiliation: Urology Clinic, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Cerruto
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Marco
authors.forename: Carolina
authors.initials: C
authors.lastname: D'Elia
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bizzotto
authors.forename: Davide
authors.initials: D
authors.lastname: De Marchi
authors.forename: Stefano
authors.initials: S
authors.lastname: Cavalleri
authors.forename: Giovanni
authors.initials: G
authors.lastname: Novella
authors.forename: Nicola
authors.initials: N
authors.lastname: Menestrina
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
mesh_terms: D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D016009:Chi-Square Distribution; D015653:Cystectomy / Q000009:adverse effects* / Q000401:mortality; D004435:Eating; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D018529:Nutritional Support; D010865:Pilot Projects; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011300:Preoperative Care; D015397:Program Evaluation; D057216:Propensity Score; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D019738:Surgically-Created Structures; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000401:mortality
chemical_list: D000700:Analgesics