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National Surgical Quality Improvement Program audit of contemporary perioperative care for radical cystectomy.
Pfail, John; Capellan, Jasmin; Passarelli, Rachel; Kaldany, Alain; Chua, Kevin; Lichtbroun, Benjamin; Srivastava, Arnav; Golombos, David; Jang, Thomas L; Pitt, Henry A; Packiam, Vignesh T; Ghodoussipour, Saum.
Afiliación
  • Pfail J; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Capellan J; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Passarelli R; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Kaldany A; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Chua K; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Lichtbroun B; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Srivastava A; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA.
  • Golombos D; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Jang TL; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Pitt HA; Rutgers Cancer Institute, New Brunswick, NJ, USA.
  • Packiam VT; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Ghodoussipour S; Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
BJU Int ; 2024 Aug 01.
Article en En | MEDLINE | ID: mdl-39087422
ABSTRACT

OBJECTIVE:

To examine the impact of increased compliance to contemporary perioperative care measures, as outlined by enhanced recover after surgery (ERAS) guidelines, among patients undergoing radical cystectomy (RC). PATIENTS AND

METHODS:

From the National Surgical Quality Improvement Program database we captured patients undergoing RC between 2019 and 2021. We identified five perioperative care

measures:

regional anaesthesia block, thromboembolism prophylaxis, ≤24 h perioperative antibiotic administration, absence of bowel preparation, and early oral diet. We stratified patients by the number of measures utilised (one to five). Statistical endpoints included 30-day complications, hospital length of stay (LOS), readmissions, and optimal RC outcome. Optimal RC outcome was defined as absence of any postoperative complication, re-operation, prolonged LOS (75th percentile, 8 days) with no readmission. Multivariable regressions with Bonferroni correction were performed to assess the association between use of contemporary perioperative care measures and outcomes.

RESULTS:

Of the 3702 patients who underwent RC, 73 (2%), 417 (11%), 1010 (27%), 1454 (39%), and 748 (20%) received one, two, three, four, and five interventions, respectively. On multivariable analysis, increased perioperative care measures were associated with lower odds of any complication (odds ratio [OR] 0.66, 99% confidence interval [CI] 0.6-0.73), and shorter LOS (ß -0.82, 99% CI -0.99 to -0.65). Furthermore, patients with increased compliance to contemporary care measures had increased odds of an optimal outcome (OR 1.38, 99% CI 1.26-1.51).

CONCLUSIONS:

Among the measures we assessed, greater adherence yielded improved postoperative outcomes among patients undergoing RC. Our work supports the efficacy of ERAS protocols in reducing the morbidity associated with RC.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: BJU Int Asunto de la revista: UROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: BJU Int Asunto de la revista: UROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido