Impact of an enhanced recovery protocol in frail patients after intracorporeal urinary diversion.

Autor: Zennami K; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan., Kusaka M; Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan., Tomozawa S; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan., Toda F; Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Toyoake, Japan., Ito K; Department of Rehabilitation, Fujita Health University Okazaki Medical Center, Okazaki, Japan., Kawai A; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan., Nakamura W; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan., Muto Y; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan., Saruta M; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan., Motonaga T; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan., Takahara K; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan., Sumitomo M; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan., Shiroki R; Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2024 Sep; Vol. 134 (3), pp. 426-433. Date of Electronic Publication: 2024 Mar 19.
DOI: 10.1111/bju.16340
Abstrakt: Objective: To determine whether an enhanced recovery after surgery (ERAS) protocol enhances bowel recovery and reduces postoperative ileus (POI) in both non-frail and frail patients after robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC).
Patients and Methods: This retrospective cohort study included 186 patients (104 with and 82 without ERAS) who underwent iRARC between 2012 and 2023. 'Frail' patients was defined as those with a low Geriatric-8 questionnaire score (≤13). The primary outcomes were postoperative bowel recovery and the incidence of POI. Secondary outcomes included length of stay (LOS), 30- and 90-day complications, 90-day readmission rate, and POI predictors.
Results: The ERAS group exhibited a significantly shorter LOS, early bowel recovery, a lower POI rate, fewer 90-day high-grade complications, and fewer 90-day readmissions than the non-ERAS group in the entire cohort. Non-frail patients in the ERAS group had a lower rate of POI (7.1% vs. 22.1%; P = 0.008), whereas ERAS did not reduce POI in frail patients (44.1% vs. 36.6%; P = 0.50). In the multivariate analysis, ERAS was associated with a reduced risk of POI in both the entire cohort (odds ratio [OR] 0.39, P = 0.01) and in non-frail patients (OR 0.24, P = 0.01), whereas ERAS was not likely to reduce POI (OR 1.14, P = 0.70) in frail patients. Prehabilitation was identified as a favourable predictor of POI.
Conclusions: The ERAS protocol did not reduce POI in frail patients after iRARC, although it enhanced bowel recovery and reduced POI in non-frail patients. Prehabilitation for frail patients might reduce POI.
(© 2024 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)
Databáze: MEDLINE
Externí odkaz: