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Keywords:

  • enhanced recovery programme;
  • open radical cystectomy

Objectives

  • To describe our experience with the implementation and refinement of an enhanced recovery programme (ERP) for radical cystectomy (RC) and urinary diversion.
  • To assess the impact on length of stay (LOS), complication and readmission rates.

Patients and Methods

  • In all, 165 consecutive patients undergoing open RC (ORC) and urinary diversion between January 2008 and April 2013 were entered into an ERP.
  • A retrospective case note review was undertaken.
  • Outcomes recorded included LOS, time to mobilisation, complication rates within the first 30 days (Clavien-Dindo classification) and readmissions.

Results

  • All patients were successfully entered into the ERP.
  • As enhanced recovery principles became embedded in the unit, LOS reduced from a mean of 14 days over the initial year of the ERP to a mean of 9.2 days.
  • The complication rate was 6.6% for Clavien ≥3, and 43.5% for Clavien ≤2. The 30-day mortality rate was 1.2%.
  • The 30-day readmission rate was 13.9%.
  • In the most contemporary subset of 52 patients: the median time after ORC to sit out of bed, mobilise and open bowels was day 1, 2 and 6, respectively.

Conclusions

  • The ERP described for patients undergoing ORC appears to be safe.
  • Benefits include early feeding, mobilisation and hospital discharge.
  • The ERP will continue to develop with the incorporation of advancing evidence and technology, in particular the introduction of robot-assisted RC.