Key Points
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Enhanced recovery programmes (ERPs) are multimodal and have preoperative, intraoperative and postoperative components
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The surgery itself is only one of many important steps; others include preoperative patient education, postoperative multimodal analgesia and early commencement of enteral nutrition
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Reappraisal of existing ERPs, assessment of patient experience and identification of areas of improvement are key to ensuring a consistently high level of care
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Discharge criteria are the tolerance of a normal diet, adequate pain control with oral analgesia, competence with either stoma care (conduit) or catheter care (neobladder) and the patient feeling adequately supported
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Follow-up support includes follow-up telephone calls, a scheduled date for clinical review and an emergency contact
Abstract
Radical cystectomy is associated with high rates of surgical morbidity. The magnitude of the surgical insult is associated with the degree of stress response, particularly in ageing patients with multiple comorbidities. Attempts to limit this response and identify areas of improvement with respect to patient selection and optimization, anaesthesia, surgical technique and postoperative care underpin the multimodal approach to enhanced recovery pathways. No single intervention significantly reduces morbidity, but the combination of many interventions at all levels of the pathway is likely to accelerate the patient journey from diagnosis to return to normal function.
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Smith, J., Pruthi, R. & McGrath, J. Enhanced recovery programmes for patients undergoing radical cystectomy. Nat Rev Urol 11, 437–444 (2014). https://doi.org/10.1038/nrurol.2014.164
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DOI: https://doi.org/10.1038/nrurol.2014.164
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