Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre
Introduction and aim: Radical Cystectomy (RC) with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track (FT) protocols have been described to reduce hospitalization, without increasing postoperatory complications. We present the one-year results of a...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2020-01-01
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| Series: | Archivio Italiano di Urologia e Andrologia |
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| Online Access: | https://pagepressjournals.org/index.php/aiua/article/view/8328 |
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| author | Daniele Romagnoli Riccardo Schiavina Lorenzo Bianchi Marco Borghesi Francesco Chessa Federico Mineo Bianchi Andrea Angiolini Carlo Casablanca Marco Giampaoli Paolo Corsi Daniele D'Agostino Eugenio Brunocilla Angelo Porreca |
| author_facet | Daniele Romagnoli Riccardo Schiavina Lorenzo Bianchi Marco Borghesi Francesco Chessa Federico Mineo Bianchi Andrea Angiolini Carlo Casablanca Marco Giampaoli Paolo Corsi Daniele D'Agostino Eugenio Brunocilla Angelo Porreca |
| author_sort | Daniele Romagnoli |
| collection | DOAJ |
| description | Introduction and aim: Radical Cystectomy (RC) with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track (FT) protocols have been described to reduce hospitalization, without increasing postoperatory complications. We present the one-year results of a dedicated protocol developed at a high volume centre.
Materials and methods: The FT protocol was designed after a review of the literature and a multidisciplinary collegiate discussion, and it was applied to patients scheduled to open RC with intestinal urinary diversion. To validate its feasibility, we compared its results with data collected from a 1:1 matched population of patients who had undergone the same surgical procedure, without the implementation of the FT protocol.
Results: We enrolled in the FT group 11 (55%) patients scheduled to RC with ileal conduit diversion, and 9 patients (45%) scheduled to orthotopic neobladder (Studer) substitution, while a numerically equivalent population was enrolled in the control group, matched according to age at surgery, BMI, gender, ASA score, CCI, preoperative stage and type of urinary diversion. No statistically significant difference was found in terms of pre-operatory and intra-operatory domains. Median overall age was 71 years (Inter Quartile Range - IQR: 63-76) and mean operatory time was 276 ± 57 minutes. Hospitalization time was significantly reduced in the FT group, considering oralization and canalization items we found a significant advantage in the FT group. No statistically significant difference was found in the control of the post-operatory pain. We found no difference, in terms of both early and late complications ratio, among the two populations. Complications graded Clavien ≥ 3 were found in 4 patients of the control group (20%), while in only one patient (5%) in the Fast Track group, though this difference was not statistically significant.
Conclusions: The Fast Track protocol developed in this study has proven to be effective in significantly reducing hospitalization time in patients submitted to RC with intestinal urinary diversion, without increasing post-operatory complications ratio. |
| first_indexed | 2024-04-13T00:05:30Z |
| format | Article |
| id | doaj.art-1f7d679489fa4efd898adb08c3223631 |
| institution | Directory Open Access Journal |
| issn | 1124-3562 2282-4197 |
| language | English |
| last_indexed | 2024-04-13T00:05:30Z |
| publishDate | 2020-01-01 |
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| series | Archivio Italiano di Urologia e Andrologia |
| spelling | doaj.art-1f7d679489fa4efd898adb08c32236312022-12-22T03:11:14ZengPAGEPress PublicationsArchivio Italiano di Urologia e Andrologia1124-35622282-41972020-01-0191410.4081/aiua.2019.4.230Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centreDaniele Romagnoli0Riccardo Schiavina1Lorenzo BianchiMarco Borghesi2Francesco Chessa3Federico Mineo Bianchi4Andrea Angiolini5Carlo Casablanca6Marco Giampaoli7Paolo Corsi8Daniele D'Agostino9Eugenio Brunocilla10Angelo Porreca11Abano Terme Hospital, Abano Terme (PD)St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO)St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO)St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO)St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO)St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO)St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO)Abano Terme Hospital, Abano Terme (PDAbano Terme Hospital, Abano Terme (PD)Abano Terme Hospital, Abano Terme (PD)St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO)Abano Terme Hospital, Abano Terme (PD)Introduction and aim: Radical Cystectomy (RC) with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track (FT) protocols have been described to reduce hospitalization, without increasing postoperatory complications. We present the one-year results of a dedicated protocol developed at a high volume centre. Materials and methods: The FT protocol was designed after a review of the literature and a multidisciplinary collegiate discussion, and it was applied to patients scheduled to open RC with intestinal urinary diversion. To validate its feasibility, we compared its results with data collected from a 1:1 matched population of patients who had undergone the same surgical procedure, without the implementation of the FT protocol. Results: We enrolled in the FT group 11 (55%) patients scheduled to RC with ileal conduit diversion, and 9 patients (45%) scheduled to orthotopic neobladder (Studer) substitution, while a numerically equivalent population was enrolled in the control group, matched according to age at surgery, BMI, gender, ASA score, CCI, preoperative stage and type of urinary diversion. No statistically significant difference was found in terms of pre-operatory and intra-operatory domains. Median overall age was 71 years (Inter Quartile Range - IQR: 63-76) and mean operatory time was 276 ± 57 minutes. Hospitalization time was significantly reduced in the FT group, considering oralization and canalization items we found a significant advantage in the FT group. No statistically significant difference was found in the control of the post-operatory pain. We found no difference, in terms of both early and late complications ratio, among the two populations. Complications graded Clavien ≥ 3 were found in 4 patients of the control group (20%), while in only one patient (5%) in the Fast Track group, though this difference was not statistically significant. Conclusions: The Fast Track protocol developed in this study has proven to be effective in significantly reducing hospitalization time in patients submitted to RC with intestinal urinary diversion, without increasing post-operatory complications ratio.https://pagepressjournals.org/index.php/aiua/article/view/8328Radical CystectomyFast TrackEnhanced Recovery After Surgery |
| spellingShingle | Daniele Romagnoli Riccardo Schiavina Lorenzo Bianchi Marco Borghesi Francesco Chessa Federico Mineo Bianchi Andrea Angiolini Carlo Casablanca Marco Giampaoli Paolo Corsi Daniele D'Agostino Eugenio Brunocilla Angelo Porreca Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre Archivio Italiano di Urologia e Andrologia Radical Cystectomy Fast Track Enhanced Recovery After Surgery |
| title | Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre |
| title_full | Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre |
| title_fullStr | Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre |
| title_full_unstemmed | Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre |
| title_short | Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre |
| title_sort | is fast track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion initial results from a single high volume centre |
| topic | Radical Cystectomy Fast Track Enhanced Recovery After Surgery |
| url | https://pagepressjournals.org/index.php/aiua/article/view/8328 |
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