CAUSES OF INCREASED HOSPITAL STAY AFTER RADICAL CYSTECTOMY IN A CLINICAL PATHWAY SETTING:

Introduction of an enhanced recovery protocol for radical cystectomy

OBJECTIVE

To describe and assess an enhanced recovery protocol (ERP) for the peri-operative management of patients undergoing radical cystectomy (RC), which was started at our institution on 1 October 2005, as RC is associated with increased morbidity and longer inpatient stays than other major urological procedures.

PATIENTS AND METHODS

An ERP was introduced in our institution that focused on reduced bowel preparation, and standardized feeding and analgesic regimens. In all, 112 consecutive patients were compared, i.e. 56 before implementing the ERP and 56 since introducing the ERP. The primary outcome measures were duration of total inpatient stay and interval from surgery to discharge, and the morbidity and mortality. Data were analysed retrospectively from cancer network and hospital records.

RESULTS

The demographics of the two groups showed no significant difference in age, gender distribution, American Society of Anesthesiologists grade, or type of urinary diversion. Re-admission, mortality and morbidity rates showed no statistically significant difference between the groups. The median (interquartile range) duration of hospital stay was 17 (15-23) days in the no-ERP group, and 13 (11-17) days in the ERP group (significantly different, P < 0.001, Wilcoxon rank-sum test). The median duration of recovery after RC was 15 (13-21) days in the no-ERP group and 12 (10-15) days in the ERP group (significantly different, P = 0.001, Wilcoxon rank-sum test).

CONCLUSION

The introduction of an ERP was associated with significantly reduced hospital stay, with no deleterious effect on morbidity or mortality.

Changes in patient characteristics and outcomes for radical cystectomy in England

OBJECTIVES

To describe temporal changes in patient characteristics and outcomes for radical cystectomy (RC) in England between 1995 and 2002, using routinely collected administrative data.

PATIENTS AND METHODS

Data were extracted from the Hospital Episode Statistics database of the Department of Health in England, describing all patients recorded as having undergone RC between 1995/1996 and 2001/2002; 8228 patients were included.

RESULTS

Of the patients who had undergone RC, two-thirds were > or = 65 years old and 75.6% were men. From 1995/1996 to 2001/2002 the annual number of RCs increased from 1013 to 1254, the proportion of patients admitted as an emergency decreased from 6.5% to 4.9%, the mean length of hospital stay decreased from 20.7 days to 18.7 days, and in-hospital mortality rates fell from 5.3% to 3.6%. The length of hospital stay and in-hospital mortality rates were higher in older patients, in female patients, and in those admitted as an emergency.

CONCLUSIONS

There was no sign of centralization of RCs over the study period, as the 25% increase in annual hospital volume was accompanied by a similar increase in the annual number of RCs. Length of hospital stay and in-hospital mortality rates have decreased.