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 .
Parenteral nutrition does not improve postoperative recovery from radical cystectomy: results of a prospective randomised trial.
BACKGROUND After radical cystectomy , patients are in a catabolic state because of postoperative stress response , extensive wound healing , and ileus . OBJECTIVE To evaluate whether recovery can be improved with total parenteral nutrition ( TPN ) in patients following extended pelvic lymph node dissection ( ePLND ) , cystectomy , and urinary diversion ( UD ) . DESIGN , SETTING , AND PARTICIPANTS We conducted a prospect i ve , r and omised , single-centre study of 157 consecutive cystectomy patients . INTERVENTION Seventy-four patients ( group A ) received TPN during the first 5 postoperative days , with additional oral intake ad libitum .  Eighty-three patients ( group B ) received oral nutrition alone . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the occurrence of postoperative complications . Secondary outcomes were time to recovery of bowel function , biochemical nutritional ( serum albumin , serum prealbumin , serum total protein ) and inflammatory ( C-reactive protein ) parameters , length of hospital stay , and costs attributed to the TPN .  The Pearson χ(2 ) test was used for dichotomous variables ; the Wilcoxon rank sum test was used for continuous variables . RESULTS AND LIMITATIONS Postoperative complications occurred in 51 patients ( 69 % ) in group A and in 41 patients ( 49 % ) in group B ( p=0.013 ) , a difference result ing from group A having more infectious complications than group B ( 32 % vs 11 % ; p=0.001 ) . Serum prealbumin and serum total protein were significantly lower in group B on postoperative day 7 but not on postoperative day 12 . Time to gastrointestinal recovery and length of hospital stay did not differ between the two groups . The costs for TPN were € 614 per patient . A potential limitation is the use of a glucose-based parenteral nutrition without lipids . CONCLUSIONS Postoperative TPN is associated with a higher incidence of complications , mainly infections , and higher costs following ePLND , cystectomy , and UD versus oral nutrition alone
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 .