Impact of enhanced recovery after surgery protocols versus standard of care on perioperative outcomes of radical cystectomy: a systematic review and meta-analysis of comparative studies

Giannarini, Gianluca; Crestani, Alessandro; Inferrera, Antonino; Rossanese, Marta; Subba, Enrica; Novara, Giacomo; Ficarra, Vincenzo

doi:10.23736/s0393-2249.19.03376-9

Cited by 40 publications

(27 citation statements)

References 36 publications

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“…Compared with the previous studies (20,25,26), our metaanalysis has the following advantages. First, our study involved seven RCTs.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, numerous studies have been employed to evaluate the impact of ERAS protocol on radical cystectomy. For instance, Giannarini et al (25) found that implementation of the ERAS protocol on radical cystectomy accelerated postoperative recovery and did not increase the risk of postoperative complications. Tyson et al (20) showed that compared with the conventional protocol, the ERAS protocol had advantages in patients undergoing cystectomy and urinary diversion.…”

Section: Discussionmentioning

confidence: 99%

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Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy

et al. 2020

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Background and objective: Radical cystectomy has been characterized as the most difficult operation in urology because of the complex surgical procedures and postoperative complications. Enhanced recovery after surgery (ERAS), which reduces the incidence of perioperative complications, has been widely used in clinical surgery. Herein, we performed a meta-analysis to evaluate the efficacy and safety of ERAS vs. conventional recovery after surgery (CRAS) on perioperative outcomes of radical cystectomy. Methods: We performed a systematic search of randomized controlled trials (RCTs) in the following databases: Medline, Embase, and the Cochrane Controlled Trials Register, based on the PICOS strategy. The reference lists of the retrieved studies were further surveyed for relevant publications. Results: Our search yielded seven RCTs containing 813 patients. The ERAS group was found to have better performance in the following parameters: length of hospital stay [mean difference (MD) = −1.12, 95% confidence interval (CI): −1.80 to −0.45, P = 0.001], time to first flatus (MD = −0.70, 95% CI: −0.98 to 0.41, P < 0.00001), and time to regular diet (MD = −0.12, 95% CI: −1.76 to −0.28, P = 0.007). However, there were no significant differences between the two groups in major complications [odds ratio (OR) = 0.91, 95% CI: 0.63 to 1.34, P = 0.64], readmission (OR = 1.15, 95% CI: 0.65 to 2.01, P = 0.63), ileus (OR = 0.75, 95% CI: 0.44 to 1.28, P = 0.29), wound infection (OR = 0.56, 95% CI: 0.31 to 1.01, P = 0.05), mortality (OR = 0.69, 95% CI: 0.24 to 1.99, P = 0.49), or time to first bowel movement (MD = −0.55, 95% CI: −1.62 to 0.53, P = 0.32). Conclusion: ERAS reduced the length of hospital stay, time to first flatus, and time to regular diet after cystectomy. Compared to CRAS protocols, ERAS protocols do not increase the risk of adverse events.

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“…Compared with the previous studies (20,25,26), our metaanalysis has the following advantages. First, our study involved seven RCTs.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy

et al. 2020

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“…Die Zeit bis zur Erholung des Verdauungstrakts und bis zur Rückkehr zu einer normalen Diät sowie der Krankenhausaufenthalt waren in der ERAS-Gruppe auch in dieser Metaanalyse signifikant kürzer. Auch hier kam es zu keinem Anstieg von schweren Komplikationen, der Mortalität oder der Krankenhauswiederaufnahmen [36].…”

Section: Strategien Zur Optimierung Der Perioperativen Morbidität − Eunclassified

Einfluss der radikalen Zystektomie auf die Lebensqualität und Strategien für deren Erhalt

2020

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ZusammenfassungDie radikale Zystektomie stellt einen wesentlichen Einschnitt in das Leben betroffener Patienten dar. Insbesondere ältere Patienten weisen nach radikaler Zystektomie oft eine begrenzte Lebenserwartung auf. Daher treten neben der reinen Tumortherapie insbesondere Aspekte der Lebensqualität in den Vordergrund.In dieser narrativen Übersichtsarbeit wurden durch selektive Literaturrecherche Faktoren identifiziert, die einen Einfluss auf die Lebensqualität der betroffenen Patienten haben können. Dazu gehören neben Strategien zur Minimierung der perioperativen Morbidität eine optimale, individualisierte Therapieplanung. Diese sollte neben Faktoren wie Alter, Komorbiditäten, Wahl der Harnableitung auch altersspezifische, physiologische Gegebenheiten des Patienten wie die Gebrechlichkeit (Frailty) berücksichtigen. Patient-reported outcome measures (PROMs) sind essenzielle Instrumente, um die Lebensqualität standardisiert zu erfassen und sollten im klinischen Ablauf weiter etabliert werden.

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“…RC is a highly complex intervention associated with a high risk of postoperative complications and adverse oncological and functional outcomes [5]. This occurs despite improvements in the quality of care provided by the introduction of minimally invasive surgical techniques [6,7], and the implementation of multimodal protocols, such as Enhanced Recovery After Surgery (ERAS) programmes, which aim to improve and accelerate patient recovery [8].…”

Section: Introductionmentioning

confidence: 99%

Frailty impact on postoperative complications and early mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review

Ornaghi

Afferi

Antonelli

et al. 2020

Arab Journal of Urology

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Objective: To assess the prevalence of frailty, a status of vulnerability to stressors leading to adverse health events, in bladder cancer patients undergoing radical cystectomy (RC), and test the impact of frailty measurements on postoperative adverse outcomes. Methods: A systematic review of English-language articles published up to April 2020 was performed. Electronic databases were searched to quantify the frailty prevalence in RC patients and assess the predictive ability of frailty indexes on RC-related outcomes as postoperative complications, early mortality, hospitalization length (LOS), costs, discharge dispositions, readmission rate. Results: Eleven studies were selected. Patients' frailty was identified by Johns Hopkins indicator (JHI) in two studies, 11-item modified Frailty Index (mFI) in four, 5-item simplified FI (sFI) in three, 15-point mFI in one, Fried Frailty Criteria in one. Considering all the frailty measurements applied, 8% and 31% of patients were frail or pre-frail, respectively. Frail (43%) and pre-frail patients (35%) were more at risk of major complications compared to non-frail (27%) using sFI; with JHI the percentages of frail and non-frail were 53% versus 19%. According to JHI and mFI frailty was related to longer LOS and higher costs. JHI identified that 3% of frail patients experience inhospital mortality versus 1.5% of non-frail. Finally, using sFI, frail (28%), and pre-frail (19%) were more likely to be discharged non-home compared to non-frail patients (8%) and had a higher risk of 30-day mortality (4% and 2% versus 1%). Conclusions: Almost half of RC patients were frail or pre-frail, conditions significantly related to an increased risk of postoperative adverse events with higher rates of major complications and early mortality. The most-used frailty index was mFI, while JHI and sFI resulted the most reliable to predict early postoperative RC-related adverse outcomes and should be routinely included in clinical practice after better standardization throughout prospective comparative studies.

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Impact of enhanced recovery after surgery protocols versus standard of care on perioperative outcomes of radical cystectomy: a systematic review and meta-analysis of comparative studies

Cited by 40 publications

References 36 publications

Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy

Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy

Einfluss der radikalen Zystektomie auf die Lebensqualität und Strategien für deren Erhalt

Frailty impact on postoperative complications and early mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review

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