title: Impact of an enhanced recovery after surgery programme in radical cystectomy. A cohort-comparative study.
abstract: OBJECTIVE
  To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital.
  
  
  METHODS
  A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared.
  
  
  RESULTS
  No statistically significant differences in overall complication rate were found (73.171 vs. 77.32%; OR 1.25, 95% CI 0.54-2.981; P=.601) nor in Clavien-Dindo>2 complications (41.463 vs. 42.268%; OR 1.033, 95% CI 0.492-2.167; P=.93), mortality, lengths of stays readmission and reoperation rates. The need for nasogastric tube insertion was lower in the ERAS group (43.902 vs. 78.351%; OR 4.624, 95% CI 2.112-10.123; P<.0001), as well as the need for total parenteral nutrition (26.829 vs. 34.021%; OR 12.234, 95% CI 5.165-28.92; P<.0001), and time under endotracheal intubation since anaesthesia induction (median [IRQ]=325 (285-355) vs. 540 (360-600) min; P<.0001).
  
  
  CONCLUSIONS
  Enhanced recovery programs in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España. Electronic address: rcasans@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Casans-Francés
authors.affiliation: Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: A T
authors.initials: AT
authors.lastname: Roberto-Alcácer
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: A C
authors.initials: AC
authors.lastname: García-Lecina
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: M L
authors.initials: ML
authors.lastname: Ferrer-Ferrer
authors.affiliation: Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: J
authors.initials: J
authors.lastname: Subirá-Ríos
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: J
authors.initials: J
authors.lastname: Guillén-Antón
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D015653:Cystectomy / Q000534:rehabilitation*; D005260:Female; D065386:Historically Controlled Study; D017052:Hospital Mortality; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control* / Q000534:rehabilitation; D011300:Preoperative Care / Q000379:methods; D015397:Program Evaluation; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000534:rehabilitation*
keywords: Cistectomía; Cystectomy; Enhanced recovery after surgery; Fast-track surgery; Recuperación intensificada tras cirugía; Rehabilitación multimodal