L’application d’un programme de réhabilitation précoce (ERAS) améliore-t-elle les résultats périopératoires après cystectomie ? [Do initial experience with an enhanced recovery program after surgery (ERAS) improve postoperative outcomes after cystectomy?]
Details
Serval ID
serval:BIB_368BDED619E6
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
L’application d’un programme de réhabilitation précoce (ERAS) améliore-t-elle les résultats périopératoires après cystectomie ? [Do initial experience with an enhanced recovery program after surgery (ERAS) improve postoperative outcomes after cystectomy?]
Journal
Progres en urologie
ISSN
1166-7087 (Print)
ISSN-L
1166-7087
Publication state
Published
Issued date
05/2018
Peer-reviewed
Oui
Volume
28
Number
6
Pages
351-358
Language
french
Notes
Publication types: Journal Article ; Observational Study
Publication Status: ppublish
Publication Status: ppublish
Abstract
To estimate the feasibility and the impact of an ERAS program after radical cystectomy for bladder cancer.
This was a retrospective study comparing a historical pre ERAS group, including all the patients undergoing cystectomy for bladder cancer from January 2013 to December 2015 with a classic procedure, and an interventional ERAS group after introducing an enhanced recovery protocol before, during and after surgery, from February 2016. The principal outcome was the postoperative length of stay. Secondary outcomes mesures were impact on perioperative complication rate (Clavien classification≥3B), readmission rate, reanimation length of stay, ileus rate and adherence to the ERAS protocol.
There were no differences between the 2 groups as far as demographics characteristics are concerned. In total, 97 patients were included, 56 in the control group, and 41 in the ERAS group. The adherence to the protocol was about 65.8%. The ERAS group had statistically significantly shorter median length of stay (D19 versus D14; P: 0.021). The major complications rate (Clavien≥3B) were about 23.2% for the control group and 12.1% for the ERAS group (P: NS). The reinsertion of nasogastric tube were higher in the control group (39.3% vs 21.9%; P: NS) and the readmission rate was about 7.1% in the control group versus 14.6% in the ERAS group (P: NS).
In conclusion, introduction and application of an enhanced recovery protocol (ERAS) after cystectomy for bladder cancer allowed for better management of postoperative outcomes. It is clearly feasible in cystectomy, and improve significantly the median postoperative length of stay. Moreover, it may be effective in terms of faster return of bowel function and reduction of majors complications.
4.
This was a retrospective study comparing a historical pre ERAS group, including all the patients undergoing cystectomy for bladder cancer from January 2013 to December 2015 with a classic procedure, and an interventional ERAS group after introducing an enhanced recovery protocol before, during and after surgery, from February 2016. The principal outcome was the postoperative length of stay. Secondary outcomes mesures were impact on perioperative complication rate (Clavien classification≥3B), readmission rate, reanimation length of stay, ileus rate and adherence to the ERAS protocol.
There were no differences between the 2 groups as far as demographics characteristics are concerned. In total, 97 patients were included, 56 in the control group, and 41 in the ERAS group. The adherence to the protocol was about 65.8%. The ERAS group had statistically significantly shorter median length of stay (D19 versus D14; P: 0.021). The major complications rate (Clavien≥3B) were about 23.2% for the control group and 12.1% for the ERAS group (P: NS). The reinsertion of nasogastric tube were higher in the control group (39.3% vs 21.9%; P: NS) and the readmission rate was about 7.1% in the control group versus 14.6% in the ERAS group (P: NS).
In conclusion, introduction and application of an enhanced recovery protocol (ERAS) after cystectomy for bladder cancer allowed for better management of postoperative outcomes. It is clearly feasible in cystectomy, and improve significantly the median postoperative length of stay. Moreover, it may be effective in terms of faster return of bowel function and reduction of majors complications.
4.
Keywords
Aged, Case-Control Studies, Cystectomy/rehabilitation, Cystectomy/statistics & numerical data, Female, Humans, Length of Stay/statistics & numerical data, Male, Morbidity, Mortality, Patient Readmission/statistics & numerical data, Postoperative Care/methods, Postoperative Care/standards, Postoperative Complications/epidemiology, Postoperative Complications/prevention & control, Reoperation/methods, Reoperation/statistics & numerical data, Retrospective Studies, Urinary Bladder Neoplasms/epidemiology, Urinary Bladder Neoplasms/rehabilitation, Urinary Bladder Neoplasms/surgery, Cystectomie, Cystectomy, Durée de séjour, Enhanced recovery after surgery, Ileus, Iléus, Length of stay, Morbi-mortality, Morbi-mortalité, Protocol, Protocole, Réhabilitation
Pubmed
Web of science
Create date
03/05/2018 17:28
Last modification date
20/08/2019 13:24
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