Introduction of an enhanced recovery protocol for radical cystectomy


Nimalan Arumainayagam, Clinical Research Registrar, Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK.



To describe and assess an enhanced recovery protocol (ERP) for the peri-operative management of patients undergoing radical cystectomy (RC), which was started at our institution on 1 October 2005, as RC is associated with increased morbidity and longer inpatient stays than other major urological procedures.


An ERP was introduced in our institution that focused on reduced bowel preparation, and standardized feeding and analgesic regimens. In all, 112 consecutive patients were compared, i.e. 56 before implementing the ERP and 56 since introducing the ERP. The primary outcome measures were duration of total inpatient stay and interval from surgery to discharge, and the morbidity and mortality. Data were analysed retrospectively from cancer network and hospital records.


The demographics of the two groups showed no significant difference in age, gender distribution, American Society of Anesthesiologists grade, or type of urinary diversion. Re-admission, mortality and morbidity rates showed no statistically significant difference between the groups. The median (interquartile range) duration of hospital stay was 17 (15–23) days in the no-ERP group, and 13 (11–17) days in the ERP group (significantly different, P < 0.001, Wilcoxon rank-sum test). The median duration of recovery after RC was 15 (13–21) days in the no-ERP group and 12 (10–15) days in the ERP group (significantly different, P = 0.001, Wilcoxon rank-sum test).


The introduction of an ERP was associated with significantly reduced hospital stay, with no deleterious effect on morbidity or mortality.