Open Access

ARTICLE

Extended hospital stay after radical cystectomy with enhanced recovery protocol

Hatim Thaker, Saum Ghodoussipour, Mateen Saffarian, Akbar Ashrafi, Gus Miranda, Jie Cai, Anne K. Schuckman, Monish Aron, Mihir Desai, Inderbir S. Gill, Siamak Daneshmand, Hooman Djaladat

The Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
Address correspondence to Dr. Hooman Djaladat, USC Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089 USA

Canadian Journal of Urology 2019, 26(1), 9654-9659.

Abstract

Introduction: To evaluate the reasons leading to an extended hospital stay (EHS) in patients undergoing radical cystectomy (RC) with postoperative enhanced recovery after surgery (ERAS) protocol.
Materials and methods: A total of 509 patients underwent RC and urinary diversion with ERAS between May 2012 and March 2017. The protocol includes no bowel preparation, early feeding, predominantly non-narcotic pain control, and μ opioid antagonists. Non-consenting/lost to follow-up patients, and those with non-urothelial carcinoma were excluded. We defined EHS as ≥ 5 postoperative days and compared the cohort to those with a length of stay (LOS) of ≤ 4 days. Demographics including modifiable and non-modifiable factors, as well as in-house complications as possible contributing factors to EHS, were reviewed.
Results: There were 279/509 (54.8%) patients who had an EHS. Median age was 73 years, 82.4% were male, and 36.6% had a Charlson comorbidity index (CCI) of > 2. Univariate analysis demonstrated that age > 65 years, CCI > 2, increased operative time, anemia requiring transfusion, and non-orthotopic diversion were associated with EHS. On multivariate analysis, advanced age, operative time, postoperative transfusion, CCI > 2, as well as surgeon-specific preferences, were associated with EHS. Within EHS patients, 86% stayed due to an in-house complication; ileus (34.3%), anemia requiring transfusion (9.8%), UTIs (9.4%), and atrial fibrillation (8.5%).
Conclusions: Advanced age, operative time, postoperative transfusion, CCI > 2, and surgeon-specific preferences are associated with an EHS following RC with ERAS. The common causes of EHS are in-house complications, mainly ileus.

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