title: Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study.
abstract: OBJECTIVE
  To determine if patients managed with a cystectomy enhanced recovery pathway (CERP) have improved quality of care after radical cystectomy (RC), as defined by a decrease in length of hospital stay (LOS) without an increase in complications or readmissions compared with those not managed with CERP.
  
  
  METHODS
  The Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study was a non-randomized quasi-experimental study. Data were collected between June 2011 and April 2015. The CERP was implemented in July 2013. The primary endpoint was LOS. Secondary endpoints were quality scores, complications and readmissions. Multivariable regression was performed. Propensity score matching was carried out to further simulate randomized clinical trial conditions. A CERP quality composite score was created and evaluated with regard to adherence to CERP elements.
  
  
  RESULTS
  The study included 79 patients managed with CERP and 121 who were not managed with CERP. After matching, there were 75 patients in the non-CERP group. The LOS was significantly different between the groups: the median LOS was 5 and 8 days for the CERP and non-CERP group, respectively (P < 0.001). Multivariable linear regression showed that any complication was the most significant predictor of total LOS at 90 days after RC. The higher the quality composite score the shorter the LOS (P < 0.001). There was no association between CERP and a greater number of complications or readmissions.
  
  
  CONCLUSIONS
  Audited quality measures in the CERP are associated with a reduction in LOS with no increase in readmissions or complications. The CERP is important for the future improvement of peri-operative care for RC and provides an opportunity to improve the quality of care provided.
authors.affiliation: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Baack Kukreja
authors.affiliation: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Kiernan
authors.affiliation: School of Nursing, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Bethany
authors.initials: B
authors.lastname: Schempp
authors.affiliation: School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Aisha
authors.initials: A
authors.lastname: Siebert
authors.affiliation: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Adriana
authors.initials: A
authors.lastname: Hontar
authors.affiliation: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nelson
authors.affiliation: Department of Public Health Sciences, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: James
authors.initials: J
authors.lastname: Dolan
authors.affiliation: Department of Surgery, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.affiliation: Department of Public Health Sciences, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Dozier
authors.affiliation: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ghazi
authors.affiliation: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Hani H
authors.initials: HH
authors.lastname: Rashid
authors.affiliation: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Guan
authors.initials: G
authors.lastname: Wu
authors.affiliation: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Messing
mesh_terms: D000359:Aftercare / Q000592:standards*; D000368:Aged; D019091:Critical Pathways; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D020127:Recovery of Function
keywords: #BladderCancer; #blcsm; cystectomy; enhanced recovery after surgery; fast track; outcomes; quality improvement