TY - JOUR
T1 - Hospital Charges and Length of Stay Following Radical Cystectomy in the Enhanced Recovery After Surgery Era
AU - Semerjian, Alice
AU - Milbar, Niv
AU - Kates, Max
AU - Gorin, Michael A.
AU - Patel, Hiten D.
AU - Chalfin, Heather J.
AU - Frank, Steven M.
AU - Wu, Christopher L.
AU - Yang, William W.
AU - Hobson, Deb
AU - Robertson, Lindsay
AU - Wick, Elizabeth
AU - Schoenberg, Mark P.
AU - Pierorazio, Phillip M.
AU - Johnson, Michael H.
AU - Stimson, C. J.
AU - Bivalacqua, Trinity J.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/1
Y1 - 2018/1
N2 - Objective To report our center's experience with enhanced recovery after surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease the length of stay (LOS) and postoperative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns. Materials and Methods Our ERAS protocol was implemented for RC in December 2015. Outcomes in ERAS patients were compared with those in RC patients from the time period before ERAS. Patients were excluded if they underwent concomitant nephroureterectomy. Results Fifty-six consecutive ERAS patients were compared with 54 pre-ERAS patients. The median charge for index hospitalization was $31,090 in the ERAS group and $35,489 in the pre-ERAS group (P =.036). The median LOS was 5.0 days in the ERAS group and 8.5 days in the pre-ERAS group (P = <.001). The pre-ERAS group had a significantly increased use of nasogastric tube (13.8% vs 30.0%) and parenteral nutrition (6.9% vs 20.4%). The overall complication rate (including infectious, renal, deep vein thrombosis and pulmonary embolism, myocardial infarction and stroke, and respiratory and gastrointestinal-related complications) was similar between the 2 groups (51.7% in the ERAS group and 62.0% in the pre-ERAS group, P =.28). Thirty- and 90-day readmissions also remained similar (19.0% vs 14.8%, P =.55, and 31.0% vs 27.7%, P =.64). The most common readmission reason was infection, specifically urinary tract infection. Conclusion Implementation of the ERAS pathway at our center resulted in significantly reduced LOS and total hospital charge, with comparable rates of complication and readmission, highlighting the need for ERAS pathways in patients undergoing RC.
AB - Objective To report our center's experience with enhanced recovery after surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease the length of stay (LOS) and postoperative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns. Materials and Methods Our ERAS protocol was implemented for RC in December 2015. Outcomes in ERAS patients were compared with those in RC patients from the time period before ERAS. Patients were excluded if they underwent concomitant nephroureterectomy. Results Fifty-six consecutive ERAS patients were compared with 54 pre-ERAS patients. The median charge for index hospitalization was $31,090 in the ERAS group and $35,489 in the pre-ERAS group (P =.036). The median LOS was 5.0 days in the ERAS group and 8.5 days in the pre-ERAS group (P = <.001). The pre-ERAS group had a significantly increased use of nasogastric tube (13.8% vs 30.0%) and parenteral nutrition (6.9% vs 20.4%). The overall complication rate (including infectious, renal, deep vein thrombosis and pulmonary embolism, myocardial infarction and stroke, and respiratory and gastrointestinal-related complications) was similar between the 2 groups (51.7% in the ERAS group and 62.0% in the pre-ERAS group, P =.28). Thirty- and 90-day readmissions also remained similar (19.0% vs 14.8%, P =.55, and 31.0% vs 27.7%, P =.64). The most common readmission reason was infection, specifically urinary tract infection. Conclusion Implementation of the ERAS pathway at our center resulted in significantly reduced LOS and total hospital charge, with comparable rates of complication and readmission, highlighting the need for ERAS pathways in patients undergoing RC.
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U2 - 10.1016/j.urology.2017.09.010
DO - 10.1016/j.urology.2017.09.010
M3 - Article
C2 - 29032237
AN - SCOPUS:85035055406
SN - 0090-4295
VL - 111
SP - 86
EP - 91
JO - Urology
JF - Urology
ER -