Simone Albisinni1, Marco Moschini2, Ettore Di Trapani3, Francesco Soria4, Andrea Mari5, Atiqullah Aziz6, Jeremy Teoh7, Ekaterina Laukhtina8,9, Keiichiro Mori8,10, David D'Andrea8, Diego M Carrion11, Wojciech Krajewski12, Mohammad Abufaraj13, Alessia Cimadamore14, Wei Shen Tan15, Ronan Flippot16, Jonathan Khalifa17, Kimberly Gonsette18, Benjamin Pradere8. 1. Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. simone.albisinni@erasme.ulb.ac.be. 2. Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland. 3. Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy. 4. Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy. 5. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. 6. Department of Urology, München Klinik Bogenhausen, Munich, Germany. 7. S.H.Ho Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong. 8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 9. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. 10. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. 11. Department of Urology, La Paz University Hospital, Madrid, Spain. 12. Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland. 13. Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan. 14. Section of Pathological Anatomy, School of Medicine, Marche Polytechnic University, United Hospitals, Ancona, Italy. 15. Division of Surgery and Interventional Science, University College London, London, UK. 16. Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France. 17. Department of Radiotherapy, Institut Claudius Regaud/Institut universitaire du Cancer de Toulouse - Oncopole, Toulouse, France. 18. Department of Anesthesiology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Abstract
PURPOSE: There is no consensus on which items of Enhanced Recovery After Surgery (ERAS) should and should not be implemented in radical cystectomy (RC). The aim of this study is to report current practices across European high-volume RC centers involved in ERAS. METHODS: Based on the recommendations of the ERAS society, we developed a survey with 17 questions that were validated by the Young Academic Urologists-urothelial group. The survey was distributed to European expert centers that implement ERAS for RC. Only one answer per-center was allowed to keep a representative overview of the different centers. RESULTS: 70 surgeons fulfilled the eligibility criteria. Of note, 28.6% of surgeons do not work with a referent anesthesiologist and 25% have not yet assessed the implementation of ERAS in their center. Avoiding bowel preparation, thromboprophylaxis, and removal of the nasogastric tube were widely implemented (> 90%application). On the other hand, preoperative carbohydrate loading, opioid-sparing anesthesia, and audits were less likely to be applied. Common barriers to ERAS implementation were difficulty in changing habits (55%), followed by a lack of communication across surgeons and anesthesiologist (33%). Responders found that performing a regular audit (14%), opioid-sparing anesthesia (14%) and early mobilization (13%) were the most difficult items to implement. CONCLUSION: In this survey, we identified the ERAS items most and less commonly applied. Collaboration with anesthesiologists as well as regular audits remain a challenge for ERAS implementation. These results support the need to uniform ERAS for RC patients and develop strategies to help departments implement ERAS.
PURPOSE: There is no consensus on which items of Enhanced Recovery After Surgery (ERAS) should and should not be implemented in radical cystectomy (RC). The aim of this study is to report current practices across European high-volume RC centers involved in ERAS. METHODS: Based on the recommendations of the ERAS society, we developed a survey with 17 questions that were validated by the Young Academic Urologists-urothelial group. The survey was distributed to European expert centers that implement ERAS for RC. Only one answer per-center was allowed to keep a representative overview of the different centers. RESULTS: 70 surgeons fulfilled the eligibility criteria. Of note, 28.6% of surgeons do not work with a referent anesthesiologist and 25% have not yet assessed the implementation of ERAS in their center. Avoiding bowel preparation, thromboprophylaxis, and removal of the nasogastric tube were widely implemented (> 90%application). On the other hand, preoperative carbohydrate loading, opioid-sparing anesthesia, and audits were less likely to be applied. Common barriers to ERAS implementation were difficulty in changing habits (55%), followed by a lack of communication across surgeons and anesthesiologist (33%). Responders found that performing a regular audit (14%), opioid-sparing anesthesia (14%) and early mobilization (13%) were the most difficult items to implement. CONCLUSION: In this survey, we identified the ERAS items most and less commonly applied. Collaboration with anesthesiologists as well as regular audits remain a challenge for ERAS implementation. These results support the need to uniform ERAS for RC patients and develop strategies to help departments implement ERAS.
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