title: The results of implementing a fast-track protocol in radical cystectomy in a tertiary hospital.
abstract: BACKGROUND
  Radical cystectomy (RC) is the urological procedure associated with the highest rates of morbidity, mortality and hospital stay. The implementation of fast-track programs seeks to speed postsurgical recovery. Its application to radical cystectomy has yielded positive results.
  
  
  OBJECTIVE
  To assess the results of the fast-track protocol in RC at our hospital, in terms of morbidity, mortality and hospital stay, comparing these results with those of patients who underwent RC following the classic protocol. To thereby ascertain whether the implementation of the fast-track protocol represents a reduced number and severity of complications and shorter hospital stays.
  
  
  METHODS
  Ambispective cohort study of patients who underwent RC between January 2010 and October 2012 by either protocol (classic and fast-track). We analyzed the patient characteristics, intraoperative variables, postoperative complications (according to the Clavien classification), hospital stay and recovery stay.
  
  
  RESULTS
  Ninety-nine patients were included, 51 following the classic protocol and 48 following the fast-track protocol. The groups were homogeneous. The hospital stay and recovery stay were longer in the classic group than in the fast-track group (29 and 2 days, respectively, vs. 17 and 1 day). There was less intraoperative bleeding in the fast track group (600mL) than in the traditional group (1,000mL). Of the 99 patients, 31 (60.8%) of the classic group presented a postoperative complication, while the fast-track group had 14 (29.2%), most of which were minor (Clavien degrees 1 and 2). In the multivariate analysis, the type of protocol and the number of comorbidities were significant.
  
  
  CONCLUSIONS
  The implementation of the fast-track protocol in RC was associated with a significant reduction in intraoperative and postoperative complications and hospital stay.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario Miguel Servet, Zaragoza, España. Electronic address: sonsa@wanadoo.es.
authors.forename: S M
authors.initials: SM
authors.lastname: Ortega-Lucea
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: J
authors.initials: J
authors.lastname: Martínez-Ubieto
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Alcañiz, Alcañiz, España.
authors.forename: D
authors.initials: D
authors.lastname: Júdez-Legaristi
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: L
authors.initials: L
authors.lastname: Muñoz-Rodriguez
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: J
authors.initials: J
authors.lastname: Gil-Bona
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: A M
authors.initials: AM
authors.lastname: Pascual-Bellosta
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D019091:Critical Pathways; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Cistectomía; Complicaciones perioperatorias; Cystectomy; Fast-track; Multimodal rehabilitation; Perioperative complications; Rehabilitación multimodal; Resultados; Results