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

TI  - Extended hospital stay after radical cystectomy with enhanced recovery protocol
T2  - Canadian Journal of Urology

PY  - 2019
VL  - 26
IS  - 1
SN  - 1488-5581

AB  - <b>Introduction:</b> 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.<br/>
<b>Materials and methods:</b> 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.<br/>
<b>Results:</b> 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%).<br/>
<b>Conclusions:</b> 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.
KW  - bladder cancer
KW  -  complications
KW  -  enhanced recovery after surgery
KW  -  radical cystectomy
KW  -  hospital stay

DO  -