Implementation of the Enhanced Recovery After Surgery Protocol for Radical Cystectomy Patients – A Single Centre Experience

Abstract Introduction and Objectives The Enhanced Recovery After Surgery (ERAS) protocol for radical cystectomy aims to facilitate postoperative recovery and hasten a return to normal daily activities. This study aims to report on the perioperative outcomes of implementation of an ERAS protocol at a single Australian institution. Methods We identified 73 patients with pT1 – T4 bladder cancer who underwent open radical cystectomy at Western Health, Victoria between June 2016 and August 2021. A retrospective analysis of a prospectively maintained database was performed. Perioperative outcomes assessed include length of hospital and ICU stay, nasogastric tube requirement and duration of postoperative ileus. Results The median age was 74 years (IQR 66 to 78) for the ERAS group and 70 years (IQR 65 to 78) for the non-ERAS group patients. All patients in each group underwent ileal conduit formation. The median length of hospital stay was 7.0 days (IQR 7.0 to 9.3) for the ERAS group and 12.0 days (IQR 8.0 to 16.0) for the non-ERAS group (p = 0.003). Within the ERAS group, 25% had a postoperative ileus, and 25% had a nasogastric tube inserted, compared with 65% (p = 0.001) and 46% (p = 0.063) respectively within non-ERAS group. The median duration from surgery to first bowel motion was 5.0 days (IQR 4.0 to 6.0) in the ERAS group and 7.5 days (IQR 4.0 to 8.0) in the non-ERAS group (p = 0.016). Conclusions Implementation of an ERAS protocol is associated with a reduction in hospital length of stay, postoperative ileus and bowel function recovery time.