RESUMEN
OBJECTIVE: The enhanced recovery after surgery program (ERAS) has become the base of perioperative management in various surgical specialties. However, limited data are available for radical cystectomy. METHODS: We have analyzed 124 patients undergoing radical cystectomy. For retrospective analysis, the patients were divided into two groups:Group A (n=72) included patients whose surgery was performed before the introduction of the ERAS protocol; and Group B (n=52) included patients who were treated following the items included in the ERAS protocol. The main objective was to assess the length of hospital stay and the permanence in intensive care units (ICU). Other variables were the use of intraoperative blood products, fluid-therapy and medical and surgical complications. RESULTS: Hospital and ICU stay were significantly shorter (pã0.001) in Group B for patients following the ERAS protocol, which led to reduce 7 hospitalization days and 25.7 hours of overall ICU stay. Regarding fluid replacement following the ERAS protocol, our study showed a statistically significant reduction in the total amount of fluid administered, both crystalloids and colloids, in Group B (pã0.001). The need of blood transfusion was also lower in Group B with a statistically significant difference (pã0.001). No statistical differences were observed regarding the incidence of surgical complications. CONCLUSIONS: Introduction of ERAS protocol in radical cystectomy decreases the length of hospital stay, permanence in critical care units, and the need for fluidtherapy and blood product transfusion. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing radical cystectomy.
Asunto(s)
Protocolos Clínicos , Cistectomía/métodos , Laparoscopía , Cuidados Posoperatorios , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Objectivo: El programa ERAS (Enhanced recovery after surgery) se ha convertido en la base del manejo perioperatorio en diversas especialidades quirúrgicas. Sin embargo, no hay evidencia suficiente que confirme su aplicación en cistectomía radical. Metodos: Hemos analizado a 124 pacientes sometidos a cistectomía radical. Para el análisis retrospectivo, los pacientes se dividieron en dos grupos: Grupo A (n=72) se han incluido a los pacientes cuya cirugía fue realizada antes de la instauración del programa ERAS; y el Grupo B (n=52) incluyó a los pacientes que se trataron siguiendo las variables incluidas en el protocolo ERAS. El objetivo principal fue valorar el tiempo de estancia hospitalaria y la permanencia en unidades de cuidados intensivos (UCI). Otras variables del estudio fueron el uso de hemoderivados, la fluidoterapia administrada y las complicaciones médicas y quirúrgicas. Resultados: La estancia hospitalaria y en UCI fue significativamente más corta (p<0,001) en los pacientes tratados siguiendo el protocolo ERAS (Grupo B), lo que llevó a reducir 7 días de hospitalización y 25,7 horas de estancia en UCI. En cuanto al reemplazo de fluidos siguiendo el protocolo ERAS, nuestro estudio mostró una reducción estadísticamente significativa en la cantidad total de fluido administrado, tanto cristaloides como coloides, (p<0,001). La necesidad de transfusión sanguínea también fue menor en el grupo B con una diferencia estadísticamente significativa (p<0,001). No se observaron diferencias estadísticas en cuanto a la incidencia de complicaciones quirúrgicas. Conclusiones: La aplicación del protocolo ERAS en cistectomía radical disminuye el tiempo de estancia hospitalaria, la permanencia en UCI, la necesidad de fluidos y la administración de hemoderivados. Sin embargo, se necesitan más y mayores estudios para probar la eficacia de ERAS en pacientes sometidos a cistectomía radical (AU)
Objective: The enhanced recovery after surgery program (ERAS) has become the base of perioperative management in various surgical specialties. However, limited data are available for radical cystectomy. Methods: We have analyzed 124 patients undergoing radical cystectomy. For retrospective analysis, the patients were divided into two groups: Group A (n=72) included patients whose surgery was performed before the introduction of the ERAS protocol; and Group B (n=52) included patients who were treated following the items included in the ERAS protocol. The main objective was to assess the length of hospital stay and the permanence in intensive care units (ICU). Other variables were the use of intraoperative blood products, fluid-therapy and medical and surgical complications. Results: Hospital and ICU stay were significantly shorter (p<0.001) in Group B for patients following the ERAS protocol, which led to reduce 7 hospitalization days and 25.7 hours of overall ICU stay. Regarding fluid replacement following the ERAS protocol, our study showed a statistically significant reduction in the total amount of fluid administered, both crystalloids and colloids, in Group B (p<0.001). The need of blood transfusion was also lower in Group B with a statistically significant difference (p<0.001). No statistical differences were observed regarding the incidence of surgical complications. Conclusions: Introduction of ERAS protocol in radical cystectomy decreases the length of hospital stay, permanence in critical care units, and the need for fluidtherapy and blood product transfusion. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing radical cystectomy (AU)
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Neoplasias de la Vejiga Urinaria/cirugía , Laparoscopía/enfermería , Cistectomía/métodos , Enfermería Perioperatoria , Estudios Retrospectivos , Laparoscopía/normasRESUMEN
OBJECTIVES: The intraoperative goaldirected fluid therapy (GDT) has become the base of perioperative management in the fast-track protocols. This program using technology to estimate cardiac output, with the aim of minimizing splanchnic hypoperfusion. However, there is insufficient evidence to confirm its application in radical laparoscopic cystectomy. METHODS: In a retrospective study, we have included 52 patients that were scheduled for radical cystectomy. In group A (n=32) patients were treated following GDT. Group B (n=18) included patients before the GDT introduction in our practice. The main objective was to assess the length of hospital stay and the permanence in intensive care units. Other variables of the study were the use of intraoperative blood products, fluid-therapy and medical and surgical complications. Statistical analysis was performed using the Mann Whitney U test for non-parametric variables and the Chi-square test for qualitative variables. Fisher's exact test was used when the sample size required it. RESULTS: The average length of hospital stay was 13.4 SD (11.0-15.9) days in group A versus 11.6 SD (8.9-14.3) days in group B (p<0.364) . The average stay in critical care unit was 25.4 hours (16.1-34.6) in group A versus 21.0 (14.9-27.1) hours in group B with no significant differences between groups. The use of blood products was 0.41 packed red blood cells in group A versus 0.49 in group B with no statistically significant differences. The average volume of crystalloid administered was 1145 ml in group A versus 2382 ml in group B (p<0.001) . In group A 656 ml of colloids were administered versus 266 ml in group B (p<0.001) . There were no statistically significant differences in the incidence of complications. CONCLUSIONS: The use of a Goal Directed Fluid Therapy in radical cystectomy is related to a greater use of colloids than crystalloids, although its implementation does not affect hospital stay length or postoperative complications. In a multimodal perioperative program a single factor, as it is for the GDT, has little effect as an independent variable, and the combination of strategies has, more likely, a greater effect.
Asunto(s)
Cistectomía , Fluidoterapia , Laparoscopía , Humanos , Tiempo de Internación , Complicaciones Posoperatorias , Estudios RetrospectivosRESUMEN
OBJETIVOS: La terapia dirigida por objetivos (TDO) se considera la base de la fluidoterapia intraoperatoria en los protocolos de fast-track (o programas ERAS). Estos programas proponen el uso de la tecnología necesaria para estimar el gasto cardiaco con el objetivo de evitar la hipoperfusión esplácnica y mejorar la recuperación. Sin embargo, no existe suficiente evidencia sobre su utilidad en casos de cistectomía radical laparoscópica (CRL). MÉTODOS: En un estudio retrospectivo, incluimos 52 pacientes que fueron intervenidos de CRL. En el grupo A (n=32) la reposición volémica se realizó según TDO de gasto cardiaco. En el grupo B (n=18) el manejo de líquidos se realizo de forma convencional. El objetivo principal de este trabajo fue valorar el tiempo de estancia hospitalario y el tiempo de permanencia en la unidad de cuidados críticos. Otros parámetros estudiados fueron la necesidad de hemoderivados, la cantidad de fluidos administrados, y la incidencia de complicaciones, tanto médicas como quirúrgicas. El análisis estadístico se realizó usando el test "U" de Mann Whitney, para las variables no parametricas y el test de "Chi cuadrado" para las variables cualitativas. Además se utilizó el Test exacto de Fisher cuando el tamaño muestral lo requirió. RESULTADOS: El promedio de días hospitalizados fue de 13,4 días (DE: 11,0-15,9) en el grupo A, frente a 11,6 días (DE: 8,9-14,3) en el grupo B (p <0,364). El promedio de estancia en la unidad de críticos fue 25,4 horas (16,1-34,6) en el grupo A versus 21,0 horas (14,9-27,1) en el grupo B (diferencias no significativas) El uso de hemoderivados fue de 0,41 concentrados de hematíes en el grupo A frente a 0,49 en el grupo B (no significativo). El promedio de cristaloides administrado fue de 1.145 cc en el grupo A frente a 2.382 cc en el grupo B (p < 0,001). En el grupo A se administraron 656 cc de coloides frente a 266 cc en el grupo B (p < 0,001). No se encontraron diferencias estadísticamente significativas en la incidencia de complicaciones. CONCLUSIONES: El uso de TDO en CRL se relaciona con mayor uso de coloides que de cristaloides, pero sin ningún impacto en el tiempo de estancia hospitalaria, en la unidad de cuidados críticos, ni en la incidencia de complicaciones. El conjunto de medidas propuestas en los programas de fast-track tienen más importancia que una única variable, como es la TDO
OBJECTIVES: The intraoperative goal-directed fluid therapy (GDT) has become the base of perioperative management in the fast-track protocols. This program using technology to estimate cardiac output, with the aim of minimizing splanchnic hypoperfusion. However, there is insufficient evidence to confirm its application in radical laparoscopic cystectomy. METHODS: In a retrospective study, we have included 52 patients that were scheduled for radical cystectomy. In group A (n=32) patients were treated following GDT. Group B (n=18) included patients before the GDT introduction in our practice. The main objective was to assess the length of hospital stay and the permanence in intensive care units. Other variables of the study were the use of intraoperative blood products, fluid-therapy and medical and surgical complications. Statistical analysis was performed using the Mann Whitney U test for non-parametric variables and the Chi-square test for qualitative variables. Fisher's exact test was used when the sample size required it. RESULTS: The average length of hospital stay was 13.4 SD (11.0-15.9) days in group A versus 11.6 SD (8.9-14.3) days in group B (p <0.364). The average stay in critical care unit was 25.4 hours (16.1-34.6) in group A versus 21.0 (14.9-27.1) hours in group B with no significant differences between groups. The use of blood products was 0.41 packed red blood cells in group A versus 0.49 in group B with no statistically significant differences. The average volume of crystalloid administered was 1145 ml in group A versus 2382 ml in group B (p <0.001). In group A 656 ml of colloids were administered versus 266 ml in group B (p <0.001).There were no statistically significant differences in the incidence of complications. CONCLUSIONS: The use of a Goal Directed Fluid Therapy in radical cystectomy is related to a greater use of colloids than crystalloids, although its implementation does not affect hospital stay length or postoperative complications. In a multimodal perioperative program a single factor, as it is for the GDT, has little effect as an independent variable, and the combination of strategies has, more likely, a greater effect