Impacto de un programa de recuperación intensificada en cistectomía radical. Estudio comparativo de cohortes

Purpose Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. Materials and methods A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. Results The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) − 3.46 d, 95% confidence interval (CI) − 4.94 to − 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61-0.94, p = 0.01] and time to defecation (MD − 1.37 d, 95% CI − 2.06 to − 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52-1.03, p = 0.07). Conclusion Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

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Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Wessels

Lenhart

Kowalewski

et al. 2020

World J Urol

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Aplicación de protocolos ERAS (Enhanced Recovery After Surgery) en pacientes cistectomizados: el camino hacia la estandarización. Una revisión sistemática

España-Navarro

Rabadán-Márquez

Pérez-Argüelles

et al. 2021

Actas Urológicas Españolas

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Implementation of ERAS (Enhanced Recovery After Surgery) protocols for radical cystectomy patients: The pathway to standardization. A systematic review

España-Navarro

Rabadán-Márquez

Pérez-Argüelles

et al. 2021

Actas Urológicas Españolas (English Edition)

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Impacto de un programa de recuperación intensificada en cistectomía radical. Estudio comparativo de cohortes

Abstract: Enhanced recovery programs in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality.

Cited by 4 publications

References 32 publications

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Aplicación de protocolos ERAS (Enhanced Recovery After Surgery) en pacientes cistectomizados: el camino hacia la estandarización. Una revisión sistemática

Implementation of ERAS (Enhanced Recovery After Surgery) protocols for radical cystectomy patients: The pathway to standardization. A systematic review

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