The use of a multimodal enhanced recovery program for patients undergoing radical cystectomy

Objective: Radical cystectomy is a major oncological procedure, which is associated with a morbidity rate of 30% and a hospital stay of approximately 15 days. The aim of this study was to examine the effect of a multimodal enhanced recovery program on the post-operative recovery period. Patients: Forty-six patients underwent radical cystectonny for invasive or high-grade bladder cancer with curative intent at a single urology unit between June 2005 and March 2009. All patients were placed on an enhanced recovery pathway, which included a change in the surgical technique and alterations in pre-, peri- and post-operative management. The main outcome measures were length of stay, time to full diet, transfusion requirement, complications and readmission rates. Results: The median length of stay in this unit was reduced from I 7 to eight days (range 6-22). There were five major complications and a readmission rate of 10.6%. Transfusion rates were not affected and there were no deaths within three months of surgery. Conclusions: We have demonstrated that this nnultimodal pathway, which also utilises a modification in the surgical technique, is both feasible and effective in order to improve the post-operative recovery and shorten hospital stay.