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Muñiz Suárez L, Subirá Ríos J, Gayarre Abril P, Montero Martorán A, Hijazo Conejos JI, García Alarcón J, García-Magariño Alonso J, Medrano Llorente P, Ramírez Fabián M, Elizalde Benito FX, Murillo Pérez C, Utrilla Ibuarben M, Asensio Matas A, Marín Zaldívar C, Casans Francés R, Ramírez Rodríguez JM, Blasco Beltrán B, Carrera-Lasfuentes P. Influence of laparoscopic surgery on the outcomes of radical cystectomy within a multimodal rehabilitation protocol. Actas Urol Esp 2024:S2173-5786(24)00001-5. [PMID: 38191025 DOI: 10.1016/j.acuroe.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION AND OBJECTIVE The implementation of Enhanced Recover After Surgery (ERAS) multimodal rehabilitation protocols in radical cystectomy has shown to improve outcomes in hospital stay and complications. The aim of this analysis is to evaluate the impact of laparoscopic surgery on radical cystectomy within a multimodal rehabilitation program. MATERIAL AND METHODS The study was carried out in a third level center between 2011 and 2020 including patients with bladder cancer submitted to radical cystectomy according to an ERAS (Enhanced Recovery After Surgery) protocol and the Spanish Multimodal Rehabilitation Group (GERM) with 20 items to be fulfilled. RESULTS A total of 250 radical cystectomies were performed throughout the study period, 42.8% by open surgery (OS) and 57.2% by laparoscopic surgery (LS). The groups are comparable in demographic and clinical variables (p > 0.05). Operative time was longer in the LS group (248.4 ± 55.0 vs. 286.2 ± 51.9 min; p < 0.001). However, bleeding was significantly lower in the LS group (417.5 ± 365.7 vs. 877.9 ± 529.7 cc; p < 0.001), as was the need for blood transfusion (33.6% vs. 58.9%; p < 0.001). Postoperative length of stay (11.5 ± 10.5 vs. 20.1 ± 17.2 days; p < 0.001), total and major complications were also significantly lower in this group (LS). The readmission rate was lower in the LS group but not significantly (36.4% vs. 29.4%; p = 0.237). The difference between 90-day mortality in both groups was not statistically significant (2.8% LS vs. 4.3% OS; p = 0.546). The differences were maintained in the multivariate models. CONCLUSIONS Laparoscopic surgery within a multimodal rehabilitation program increases operative time but significantly decreases intraoperative bleeding, transfusion requirements, postoperative length of stay, and complications.
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Affiliation(s)
- L Muñiz Suárez
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - J Subirá Ríos
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - P Gayarre Abril
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Montero Martorán
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J I Hijazo Conejos
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J García Alarcón
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - P Medrano Llorente
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - M Ramírez Fabián
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - F X Elizalde Benito
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - C Murillo Pérez
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - M Utrilla Ibuarben
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Asensio Matas
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - C Marín Zaldívar
- Servicio de Anestesiología y Reanimación, Hospital MAZ, Zaragoza, Spain
| | - R Casans Francés
- Servicio de Anestesiología y Reanimación, Hospital MAZ, Zaragoza, Spain
| | - J M Ramírez Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - B Blasco Beltrán
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Ruiz Torres B, Ramos Paesa C, Rivero Salvador T, Marín Zaldívar C, Gil Pérez D. Enterococcus faecium meningitis secondary to epidural anesthesia. About a case and review of the literature. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:357-360. [PMID: 33358426 DOI: 10.1016/j.redar.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 06/12/2023]
Abstract
Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode. We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.
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Affiliation(s)
- B Ruiz Torres
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa de Zaragoza, Zaragoza, España.
| | - C Ramos Paesa
- Unidad de Enfermedades Infecciosas, Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, España
| | - T Rivero Salvador
- Servicio de Anestesiología y Reanimación, Hospital San Pedro de Logroño, La Rioja, España
| | | | - D Gil Pérez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, España
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