2024 FSA Podium and Poster Abstracts

S002: IMPACT OF ENHANCED RECOVERY AFTER SURGERY ON OUTCOMES IN CYSTECTOMY FOR BLADDER CANCER: A RETROSPECTIVE ANALYSIS
Kelley Martin, MD; Mayank Kotadia; Benjamin Cipion; Lindsey Roundtree, RN; Starr Dix, APRN; Paul Crispen, MD; Basma Mohamed, MBChB; University of Florida

Background: Radical cystectomy is the gold standard surgical treatment for patients diagnosed with bladder cancer². Radical cystectomy is an invasive procedure that often leads to prolonged hospital stays and high rates of readmissions after surgery^1,2. Enhanced Recovery After Surgery (ERAS) protocols have been developed to optimize patient recovery following major surgery. As a multimodal, multidisciplinary approach to enhance patient care, ERAS has been studied with promising results. While ERAS clinical pathways have been studied and implemented in other surgical subspecialties (specifically colorectal and orthopedic surgery), their application to urologic procedures needs to be more widely adopted. Recent systematic reviews and meta-analyses have suggested that implementing ERAS protocols for elective cystectomy improves perioperative outcomes, including length of hospital stay and complication rate. This study aims to evaluate the impact of ERAS protocol on perioperative outcomes in elective radical cystectomy patients at our institution.

Methods: This is a retrospective cohort study of patients 18 years of age and older who underwent elective cystectomy for bladder cancer after implementation of the ERAS clinical pathway (implemented October 2022-June 2023); this was compared to a pre-ERAS historical cohort. Patients undergoing emergent or non-elective/urgent cystectomy or if the indication is non-cancer were excluded from the study. Primary outcomes: length of hospital stay and length of ICU stay. Secondary outcomes: incidence of postoperative complications, 30-day readmission rate, and rate of non-home discharge.

Results: 70 patients were included in the analysis: 36 in the pre-ERAS group and 34 in the ERAS group. The patients' basic demographics were not statistically significant between the groups (Table 1). Patients in the ERAS group had higher DASI METs compared to the pre-ERAS group (6.5 ± 1.5 vs. 5.5 ± 1.6, P=0.012) and a higher rate of robot-assisted approach (55.88% vs. 27.78%, P=0.0157). There was a decrease in postoperative ICU admission (17% vs. 36.9%, P=0.049) in the ERAS group, which was statistically significant. There was a statistically significant decrease in hemodynamic instability (2.94% vs. 19.44%, P=0.021), septic shock (0% vs. 8.33%, P=0.042), and ileus (23.53% vs. 52.78%, P=0.011) in the ERAS cohort. There was a decrease in mortality in the ERAS group (8.82% vs. 36.11%, P=0.0005) which was statistically significant.

Discussion: The results of this retrospective analysis showed that within the first 8 months of implementing the ERAS pathway, there was a statistically significant difference in the rate of complications, including hemodynamic instability, septic shock, and ileus. There was no significant difference in ambulation, myocardial infarction, pulmonary complications, acute kidney injury, surgical site infection, day of first bowel movement, or delirium. There was also no significant difference in 30-day readmission or reoperation rate or length of hospital or ICU stay; however, the rate of postoperative ICU admission was significant. This study demonstrates that ERAS has been associated with improved outcomes in patients undergoing cystectomy for bladder cancer. The results show the need to continue improving the ERAS pathways to impact the perioperative outcomes further.