Early complications after radical cystectomy before implementation of the ERAS concept (Enhanced Recovery After Surgery)
Authors:
Šárka Kudláčková; Igor Hartmann; Veronika Lounová; Jiří Neier
Authors‘ workplace:
Urologická klinika Fakultní nemocnice Olomouc
Published in:
Ces Urol 2023; 27(2): 109-110
Category:
Original article
Overview
Objective: Radical cystectomy (RACE) is an operation with numerous complications. The effort to reduce them led to the introduction of the ERAS (Enhanced Recovery After Surgery) concept used in colorectal surgery. Our goal is to demonstrate its benefits also in urological operations with interventions on the bowel.
Material and methods: Before inclusion in the study, we evaluated a group of 86 patients who underwent RACE at our institution in the period 1/2017–12/2019. A Bricker ileostomy, a continent Studer reservoir, or a ureterocutaneostomy or nephrostomy were used for urine derivation. Descriptive characteristics (age, gender, Charleson comorbidity index, cigarette abuse, radiotherapy or chemotherapy, transient abdominal surgery) were evaluated. In addition, blood loss, time of surgery and postoperative complications, and length of hospitalization were recorded. Postoperative complications were classified as early and late. We evaluated early complications according to the Clavien-Dindo classification.
Results: In our group, we recorded a mortality of 1,2 % and a morbidity of 59.3 %. Of these, 41.8 % were early complications. Most of the early complications were grade I and II according to the Clavien-Dindo classification. The most common early complications were paralytic ileus and pneumonia. Of the late complications, stenosis of the ureteroileal anastomosis occurred most often. In 17.4 % of patients, the hospitalization period was longer than 20 days.
Conclusion: The results we achieved before taking into account the ERAS study corresponds to the number of complications reported in the literature. These results will be compared with the set of patients operated on during 2023 in which we will apply the ERAS approach with 80% adherence to the protocol.
Keywords:
ERAS – radical cystectomy – postoperative complications.
Sources
1. Richards KA, Steinberg GD. Perioperative outcomes in radical cystectomy: how to reduce morbidity? Curr Opin Urol. 2013; 23(5): 456–65.
2. Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009; 55(1): 164–74.
3. Nelson MH, Quek ML. Perioperative mortality following radical cystectomy: the slippery slope of complications. Transl Androl Urol. 2019; 8(Suppl. 3): S289–S290.
4. Cerantola Y, Valerio M, Persson B, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS(®)) society recommendations. Clin Nutr. 2013; 32(6): 879–87.
5. Čapka D, Kolombo I, Klézl P, et al. Radikální cystektomie v éře ERAS. Urol. praxi. 2017; 18(3): 98–104.
6. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg. 2019; 43(3): 659–695.
7. Clavien PA, Barkun J, de Oliveira ML et al. The Clavien‑Dindo classification of surgical complications: five‑year experience. Ann Surg. 2009; 250(2): 187–96.
8. Koppie TM, Serio AM, Vickers AJ, et al. Age‑adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer. 2008; 112(11): 2384–92.
9. Vetterlein MW, Klemm J, Gild P, et al. Improving Estimates of Perioperative Morbidity After Radical Cystectomy Using the European Association of Urology Quality Criteria for Standardized Reporting and Introducing the Comprehensive Complication Index. Eur Urol. 2020; 77(1): 55–65. g 29. PMID: 31473012.
10. Peerbocus M, Wang ZJ. Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta‑Analysis. Res Rep Urol. 2021; 13: 535–547.
11. Cakir H, van Stijn MF, Lopes Cardozo AM, et al. Adherence to Enhanced Recovery After Surgery and length of stay after colonic resection. Colorectal Dis. 2013; 15(8): 1019–25.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2023 Issue 2
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