title: 90-Day complication rate in patients undergoing radical cystectomy with enhanced recovery protocol: a prospective cohort study.
abstract: OBJECTIVE
  To report 90-day complication rates following radical cystectomy (RC) with enhanced recovery after surgery (ERAS) protocol.
  
  
  METHODS
  All consecutive patients who underwent open RC with ERAS protocol from 2012 to 2014 were included. The protocol includes no bowel preparation or NGT, early feeding, predominantly non-narcotic pain management and μ-opioid antagonists. Non-consenting and lost to follow-up patients were excluded. All patients were closely followed up, and 90-day complication (Clavien-Dindo grading), readmission and emergency room (ER) visits were prospectively recorded.
  
  
  RESULTS
  One hundred and sixty-nine cases with a median age of 71 years were included in the study. 90-Day major and minor complication rates were 24.3 and 53.9 %, respectively. The most common complications were infectious and gastrointestinal. The 90-day ER visit rate was 37.9 %, whereas the readmission rate was 29.6 %. The most common cause of hospital readmission and ER visits was infections.
  
  
  CONCLUSIONS
  Radical cystectomy and urinary diversion with enhanced recovery protocol is a morbid surgery. The most common complication, cause of ER visit and readmission is yet infections. Further studies on methods to decrease these rates are underway.
authors.affiliation: Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA. djaladat@med.usc.edu.
authors.forename: Hooman
authors.identifier: http://orcid.org/0000-0002-1984-3556
authors.initials: H
authors.lastname: Djaladat
authors.affiliation: USC Institute of Urology, USC School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
authors.forename: Behrod
authors.initials: B
authors.lastname: Katebian
authors.affiliation: Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Soroush T
authors.initials: ST
authors.lastname: Bazargani
authors.affiliation: Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.affiliation: Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.affiliation: Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Schuckman
authors.affiliation: Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods
keywords: Bladder cancer; Complications; Cystectomy; Enhanced recovery