A combination of enhanced recovery after surgery and prehabilitation pathways improves perioperative outcomes and costs for robotic radical prostatectomy. Issue 18 (8th July 2020)

• Record Type: Journal Article
• Authors: Ploussard, Guillaume; Almeras, Christophe; Beauval, Jean‐Baptiste; Gautier, Jean‐Romain; Garnault, Valérie; Frémont, Natacha; Dallemagne, Stéphanie; Loison, Guillaume; Salin, Ambroise; Tollon, Christophe
• Is Part Of: Cancer. Volume 126:Issue 18(2020)
• Page Start: 4148
• Page End: 4155
• Publication Date: 2020-07-08
• Subjects: enhanced recovery after surgery -- outpatient -- prehabilitation -- prostate cancer -- radical prostatectomy; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.33061
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: An enhanced recovery after surgery (ERAS) pathway has shown benefit in oncologic surgery. However, literature is scarce regarding the impact of this pathway, alone or combined with prehabilitation (PreHab) programs, on outcomes after robot‐assisted radical prostatectomy (RARP). Methods: Included in this study were 507 consecutive patients undergoing RARP from 2014 to 2019. The primary endpoint was duration of hospital stay. Secondary outcomes included intraoperative blood loss, operative duration, readmission rate, and overall costs. Univariate and multivariate comparisons were performed according to the ERAS and PreHab program status. Results: ERAS patients had shorter hospital stays ( P < .001), reduced operative times ( P < .001), and decreased blood loss ( P < .001) in comparison with non‐ERAS patients. Shorter hospital stays were not associated with an increased readmission rate (7.9% [stable over time]; P = .757). Patients from an ERAS−/PreHab− group had a longer hospital stay (4.7 days) than those from an ERAS+/PreHab− group (3.5 days) and those from an ERAS+/PreHab+ group (1.6 days; P < .001). In a multivariate analysis, operative time and perioperative pathway (odds ratio for ERAS, 0.144; P < .001; odds ratio for ERAS and PreHab, 0.025; P < .001) were independently predictive for a prolonged length of stay ( P < .001). Costs significantly decreased when ERAS and PreHab pathways were combined. Conclusions: The implementation of ERAS and PreHab programs significantly changes the postoperative course of patients and may synergistically optimize RARP outcomes. The combination of these pathways improves patient recovery and is associated with reduced lengths of stay, blood loss, operative times, and costs without an increase in the postdischarge readmission rate. Abstract : This study shows that enhanced recovery after surgery and prehabilitation pathways improve patient recovery after robotic radical prostatectomy. The combination of these pathways is associated with reduced lengths of stay, blood loss, operative times, and costs without an increase in the postdischarge readmission rate.