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Vangheluwe L, Legeay M, Surlemont L, Dupuis H, Defortescu G, Cornu JN, Pfister C. Clinical impact of an enhanced recovery protocol implementation for nephrectomy and radical prostatectomy. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102674. [PMID: 38944244 DOI: 10.1016/j.fjurol.2024.102674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) is a combination of multimodal pathways to improve surgical outcomes. Recommendations for radical cystectomy have been published by the ERAS society for the cystectomy but a lack of evidence is observed for urological procedures such as nephrectomy (Ne) and radical prostatectomy (RP). The aim of our study was to evaluate the impact of enhanced recovery protocol implementation for Ne ad RP at our academic institution. METHODS We performed a retrospective, monocentric, comparative analysis, pre and post implementation of an enhanced recovery protocol for patients undergoing robotic-assisted radical prostatectomy or nephrectomy (partial or total) for cancer. The primary endpoint was the mean length of stay (LOS). Secondary endpoints included 30-days readmission, postoperative complications, 90 days survival, and oncologic outcome at 6 months. RESULTS We included 264 patients between January, 2019, and December, 2020. Statistical analysis was performed separately by type of surgery. The LOS of patients included in the ERP protocol was decreased on average by 1.3 days IC95% [-2.50; -0.08], P<0.001 for nephrectomies and by 2.2 days IC95% [-3.72; -0.62] P<0.001 for prostatectomies, compared to non-ERP patients. There were no more re-admission, death or oncologic recurrence. CONCLUSION In our experience, ERP for oncological nephrectomy and prostatectomy reduced the length of stay, without increasing postoperative complications and readmission. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucie Vangheluwe
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France.
| | - Mathilde Legeay
- Service d'anesthésie réanimation, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | - Louis Surlemont
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | - Hugo Dupuis
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | | | - Jean Nicolas Cornu
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | - Christian Pfister
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
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Myers AA, Geldmaker LE, Haehn DA, Ball CT, Thiel DD. Evaluation of Routine Postoperative Labs Following Robotic Assisted Partial Nephrectomy in Patients With Normal Preoperative Renal Function. Urology 2021; 160:117-123. [PMID: 34818522 DOI: 10.1016/j.urology.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate predictors of abnormal routine postoperative day 1 (POD1) labs in patients with normal pre-operative renal function following robotic assisted partial nephrectomy (RAPN) and the associated clinical outcomes of these lab results. METHODS We analyzed 500 consecutive RAPN from a single surgeon series. Patients with chronic kidney disease (CKD) III or greater were excluded from the study. Three hundred ninty-three RAPN were included in the analysis. Routine POD1 lab tests including hemoglobin (Hgb), creatinine, potassium, and sodium were evaluated to determine rates of abnormal values and rates of clinical intervention. Abnormal Hgb at POD1 was defined as <8 g/dL or ≥3 g/dL decrease from the preoperative (baseline) value. Abnormal sodium (Na) preoperatively and postoperatively was defined as <135 mEq/L or >145 mEq/L. Abnormal potassium (K) was defined preoperatively and POD1 as <3.5 mEq/L or >5 mEq/L. RESULTS Of 37.4% (147/393) had one or more abnormal labs at POD1. Of the 101 patients with abnormal Hgb, 15 patients required blood transfusion. Twenty-six patients had abnormal sodium for which two were treated with IV fluids. Twenty-seven patients had potassium abnormalities (12/25 were hypokalemia). Acute kidney injury stage I was seen in 27 patients (6.9%) and stage II in 3 (0.8%). Patients with abnormal labs were more likely to have larger renal mass, higher R.E.N.A.L. scores, intraoperative complications, longer operative times, and higher EBL on multivariate analysis. CONCLUSION POD1 serum laboratory tests appear to be necessary following RAPN in patients with normal pre-operative renal function.
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Affiliation(s)
| | | | | | - Colleen T Ball
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL.
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Brooks NA, Kokorovic A, McGrath JS, Kassouf W, Collins JW, Black PC, Douglas J, Djaladat H, Daneshmand S, Catto JWF, Kamat AM, Williams SB. Critical analysis of quality of life and cost-effectiveness of enhanced recovery after surgery (ERAS) for patient's undergoing urologic oncology surgery: a systematic review. World J Urol 2020; 40:1325-1342. [PMID: 32648071 DOI: 10.1007/s00345-020-03341-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Enhanced recovery after surgery (ERAS) protocols have been implemented across a variety of disciplines to improve outcomes. Herein we describe the impact of ERAS on quality of life (QOL) and cost for patients undergoing urologic oncology surgery. METHODS A systematic literature search using the MEDLINE, Scopus, Clinictrials.gov, and Cochrane Review databases for studies published between 1946 and 2020 was conducted. Articles were reviewed and assigned a risk of bias by two authors and were included if they addressed ERAS and either QOL or cost-effectiveness for patients undergoing urologic oncology surgery. RESULTS The literature search yielded a total of 682 studies after removing duplicates, of which 10 (1.5%) were included in the review. Nine articles addressed radical cystectomy, while one addressed ERAS and QOL for laparoscopic nephrectomy. Six publications assessed the impact of ERAS on QOL domains. Questionnaires used for assessment of QOL varied across studies, and timing of administration was heterogeneous. Overall, ERAS improved patient QOL during early phases of recovery within the realms of bowel function, physical/social/cognitive functioning, sleep and pain control. Costs were assessed in 4 retrospective studies including 3 conducted in the United States and one from China all addressing radical cystectomy. Studies demonstrated either decreased costs associated with ERAS as a result of decreased length of stay or no change in cost based on ERAS implementation. CONCLUSION While limited studies are published on the subject, ERAS implementation for radical cystectomy and laparoscopic nephrectomy improved patient-reported QOL during early phases of recovery. For radical cystectomy, there was a decreased or neutral overall financial cost associated with ERAS. Further studies assessing QOL and cost-effectiveness over the entire global period of care in a variety of urologic oncology surgeries are warranted.
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Affiliation(s)
- Nathan A Brooks
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrea Kokorovic
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John S McGrath
- Department of Urology, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, McGill, Montreal, QC, Canada
| | - Justin W Collins
- Department of Urology, University College London Hospital, London, UK
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - James Douglas
- Department of Urology, University Hospital of Southampton, Hampshire, UK
| | - Hooman Djaladat
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
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Althaus AB, Chang P, Mao J, Olugbade K, Taylor K, Dewey L, Percy A, Crociani C, McNally K, Wagner AA. Patient-Reported Quality of Life and Convalescence After Minimally Invasive Kidney Cancer Surgery. Urology 2020; 144:123-129. [PMID: 32603743 DOI: 10.1016/j.urology.2020.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/25/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To better characterize recovery after minimally invasive kidney surgery, we present a study describing patient-reported health-related quality of life (HRQOL) following minimally invasive radical nephrectomy (RN) and partial nephrectomy (PN). METHODS Patients who underwent minimally invasive PN or RN for renal cancer were invited to enroll in a prospective, patient-reported HRQOL study using the Convalescence and Recovery Evaluation (CARE) instrument and Short Form-12. Patients completed questionnaires at baseline, 2, 4, 8, and 12 weeks after surgery. Mixed repeated measures model were used to assess time effect on HRQOL scores and predictors of scores within each surgery groups. RESULTS One hundred seventy-seven patients were included in the study: 50 had RN and 127 had PN. At 2 weeks, both groups had significant decreases in Overall CARE, as well as the Pain, Gastrointestinal, and Activity domain scores which remained slightly below baseline at 4 weeks. At 4 weeks only 50% of patients in both the RN and PN cohorts returned to baseline overall CARE score. By 12 weeks 82% returned to baseline overall CARE score in the RN group while 76% of patients did so in the PN group. CONCLUSION Convalescence after minimally invasive renal surgery can often extend beyond 4 weeks post-treatment in PN and RN subjects. This information may be used to provide more accurate preoperative counseling in an attempt to improve overall patient satisfaction.
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Affiliation(s)
- Adam B Althaus
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Jialin Mao
- Weill Cornell Medical College; New York, NY
| | - Kola Olugbade
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Kimberly Taylor
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Lauren Dewey
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Andrew Percy
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Catrina Crociani
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Kyle McNally
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Andrew A Wagner
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA.
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