Sephalie Y Patel1, Rosemarie E Garcia Getting2, Brandon Alford3, Karim Hussein3, Braydon J Schaible4, David Boulware4, Jae K Lee4, Scott M Gilbert5,6, Julio M Powsang5, Wade J Sexton5, Philippe E Spiess5, Michael A Poch5. 1. Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA. Sephalie.Patel@Moffitt.org. 2. Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA. 3. University of South Florida, Morsani College of Medicine, Tampa, FL, USA. 4. Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 5. Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 6. Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Abstract
INTRODUCTION: Although enhanced recovery after surgery (ERAS) components include both anesthesia and surgical care processes, it is unclear whether a multidisciplinary approach to implementing ERAS care processes improves clinical outcomes. The addition of multidisciplinary care with anesthesiology-related components to an existing ERAS protocol for radical cystectomy at a US comprehensive cancer center provided an opportunity to compare short- and long-term outcomes. METHODS: We retrospectively compared the outcomes of 116 consecutive patients who underwent cystectomy after implementation of a multidisciplinary ERAS protocol with those of a historical control group of 143 consecutive patients who had been treated with a surgical ERAS protocol. Length of stay, return of bowel function, rate of blood transfusion, nausea, pain, and readmission rates were examined. RESULTS: Implementation of a multidisciplinary ERAS protocol was associated with better postsurgical symptom control, as indicated by lower rates of patient-reported nausea (P < .05). Multivariate Poisson regression analysis showed a decrease in estimated intraoperative transfusions (P ≤ .001) after adjusting for the effects of potential confounding variables. There were no statistically significant differences noted in length of stay, return of bowel function, 30- and 90-day complications, or readmissions. CONCLUSION: This is the first study to investigate the effects of adding anesthesia ERAS components to an existing surgical ERAS protocol for radical cystectomy. We found that with the addition of anesthesia-related interventions, there was a decrease in transfusions and nausea.
INTRODUCTION: Although enhanced recovery after surgery (ERAS) components include both anesthesia and surgical care processes, it is unclear whether a multidisciplinary approach to implementing ERAS care processes improves clinical outcomes. The addition of multidisciplinary care with anesthesiology-related components to an existing ERAS protocol for radical cystectomy at a US comprehensive cancer center provided an opportunity to compare short- and long-term outcomes. METHODS: We retrospectively compared the outcomes of 116 consecutive patients who underwent cystectomy after implementation of a multidisciplinary ERAS protocol with those of a historical control group of 143 consecutive patients who had been treated with a surgical ERAS protocol. Length of stay, return of bowel function, rate of blood transfusion, nausea, pain, and readmission rates were examined. RESULTS: Implementation of a multidisciplinary ERAS protocol was associated with better postsurgical symptom control, as indicated by lower rates of patient-reported nausea (P < .05). Multivariate Poisson regression analysis showed a decrease in estimated intraoperative transfusions (P ≤ .001) after adjusting for the effects of potential confounding variables. There were no statistically significant differences noted in length of stay, return of bowel function, 30- and 90-day complications, or readmissions. CONCLUSION: This is the first study to investigate the effects of adding anesthesia ERAS components to an existing surgical ERAS protocol for radical cystectomy. We found that with the addition of anesthesia-related interventions, there was a decrease in transfusions and nausea.
Authors: Scott C Johnson; Zachary L Smith; Shay Golan; Joseph F Rodriguez; Norm D Smith; Gary D Steinberg Journal: Urol Oncol Date: 2017-08-01 Impact factor: 3.498
Authors: Katherine A Morgan; William P Lancaster; Megan L Walters; Stefanie M Owczarski; Carlee A Clark; Julie R McSwain; David B Adams Journal: J Am Coll Surg Date: 2016-01-14 Impact factor: 6.113
Authors: Praveen Pillai; Irene McEleavy; Matthew Gaughan; Christopher Snowden; Ian Nesbitt; Garrett Durkan; Mark Johnson; Joseph Cosgrove; Andrew Thorpe Journal: J Urol Date: 2011-10-19 Impact factor: 7.450
Authors: Ahmet Murat Aydin; Richard R Reich; Biwei Cao; Salim K Cheriyan; Ali Hajiran; Logan Zemp; Alice Yu; Michael A Poch; Wade J Sexton; Roger Li; Scott M Gilbert Journal: Urol Oncol Date: 2021-10-08 Impact factor: 3.498
Authors: Alireza Ghoreifi; Michael F Basin; Saum Ghodoussipour; Soroush T Bazargani; Erfan Amini; Mohammad Aslzare; Jie Cai; Gus Miranda; Shihab Sugeir; Sumeet Bhanvadia; Anne K Schuckman; Siamak Daneshmand; Philip Lumb; Hooman Djaladat Journal: Int Urol Nephrol Date: 2021-06-04 Impact factor: 2.370
Authors: W Jonathan Dunkman; Michael W Manning; John Whittle; John Hunting; Edward N Rampersaud; Brant A Inman; Julie K Thacker; Timothy E Miller Journal: Perioper Med (Lond) Date: 2019-08-22
Authors: F Wessels; M Lenhart; K F Kowalewski; V Braun; T Terboven; F Roghmann; M S Michel; P Honeck; M C Kriegmair Journal: World J Urol Date: 2020-03-02 Impact factor: 4.226