Abstract: PD58-03
Sources of Funding: None

Introduction

Enhanced recovery after surgery (ERAS) protocols have been shown to shorten length of stay and improve outcomes in patients undergoing radical cystectomy. In this study, we investigate the importance of compliance within our protocol on post-operative outcomes.

Methods

Using an IRB approved, prospectively maintained database, 303 consecutive patients were identified who underwent open radical cystectomy with ERAS pathway from 7/2013 to 12/2015. Compliance was measured by a Composite Compliance Score (CCS) constructed from 18 interventions (Table 1). Median CCS was 85%, and 157 patients with lower overall compliance (CCS< 85%) were compared to 146 with higher compliance (CCS>=85%).

Results

Patients in the more compliant group were younger, more likely to have orthotopic urinary diversion, received less blood transfusions and had shorter operative times (Table 2). On univariate analysis, more compliant patients had shorter hospital stays, significantly less GI related and high grade (clavien III or higher) complications at 30 and 90 days (Table 3). Multivariable linear regression modeling showed that higher compliance was significantly associated with shorter hospital stay ( β= -1.11, p<0.01,). Logistic regressions also revealed that higher compliance reduced the risks of GI related complications (OR=0.47, p<0.01), and 30-day high-grade complications (OR=0.39, p=0.026).

Conclusions

Patients with better compliance to our ERAS protocol have decreased length of stay by more than one day following cystectomy, reduced risk of high-grade and GI complications when compared to those with lower compliance. Our results strengthen the evidence for implementation of enhanced recovery protocols.

Funding

None