Impact of Perioperative Multidisciplinary Rehabilitation Pathway on Early Outcomes after Robot-Assisted Radical Cystectomy: A Matched Analysis

Bladder Cancer

Urology. 2020 Sep 3:S0090-4295(20)31053-0. doi: 10.1016/j.urology.2020.05.113. Online ahead of print.


OBJECTIVE: To investigate the effect of incorporating physical rehabilitation, nutrition and psychosocial care as part of the "NEEW" (Nutrition, Exercise, patient Education and Wellness) on perioperative outcomes after Robot-Assisted Radical Cystectomy (RARC).

METHODS: Patients were divided into 2 groups: pathway group (NEEW in addition to ERAS), versus pre-pathway group, before NEEW initiation (ERAS only). Propensity score matching was performed (ratio 1:2 ratio). Perioperative outcomes were analyzed and compared. Multivariate analyses were modeled to assess for association between NEEW pathway and postoperative outcomes.

RESULT: 192 were included in the study: 64 patients (33%) in the pathway group vs. 128 patients (67%) in the pre-pathway group. Pathway group had shorter median inpatient stay (5 vs 6 days, p<0.01), faster bowel recovery (3 vs 4 days, p < 0.01), and better pain scores, and demonstrated fewer 30-day high grade complications (5% vs 16%, p=0.02). On multivariate analysis, the NEEW pathway was associated with shorter hospital stay (1.75 days shorter), faster bowel recovery (1 day faster), longer functional mobility time (4 mins longer) and less pain scores (average 1 point less).

CONCLUSION: Standardized perioperative pathway with weekly multidisciplinary team meeting was associated with improved short-term perioperative outcomes after RARC.