Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .
Early and late perioperative outcomes following radical cystectomy: 90-day readmissions, morbidity and mortality in a contemporary series.
PURPOSE  Radical cystectomy  remains associated with significant morbidity . Most series report outcomes with relatively short-term followup that may underestimate the true magnitude of the procedure and many report length of hospital stay but ignore readmission rates . We analyzed the predictors of early ( 30 days or less ) , late ( 31 to 90 days ) and cumulative 90-day hospital readmissions , as well as morbidity and mortality rates . MATERIAL S AND METHODS We review ed our prospect ively collected data base of 753 patients who underwent radical cystectomy for urothelial cancer between January 2001 and December 2007 . We examined the relationship between clinical variables and readmission rates during the early , late and 90-day postoperative period , and review ed mortality and perioperative morbidity rates . RESULTS There were 200 ( 26.6 % ) patients readmitted in the first 90 days following radical cystectomy . Of these patients 148 ( 19.7 % ) were readmitted early , 81 ( 10.8 % ) were readmitted late , and 29 ( 3.9 % ) had an early and late readmission . Logistical regression revealed gender ( OR 1.50 , 95 % CI 1.00 - 2.27 , p = 0.05 ) , age adjusted Charlson comorbidity index ( OR 1.19 , 95 % CI 1.06 - 1.34 , p = 0.003 ) and any postoperative complications before discharge home ( OR 1.84 , 95 % CI 1.19 - 2.83 , p = 0.006 ) as independent predictors of 90-day readmission . The 30 and 90-day mortality rates were 2.1 % ( 16 ) and 6.9 % ( 52 ) , respectively . CONCLUSIONS Readmission rates after radical cystectomy are significant , approaching 27 % within the first 90 days . Gender and age adjusted Charlson comorbidity index were independent predictors providing preoperative information identifying patients more likely to require readmission or possibly to benefit from a longer initial hospital stay
Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .