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 .
Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort.
BACKGROUND Despite recent improvements , radical cystectomy ( RC ) is still associated with adverse rates for 90-d mortality . OBJECTIVE To vali date the performance of the Isbarn nomogram incorporating age and postoperative tumor characteristics for predicting 90-d RC mortality in a multicenter series and to generate a new nomogram based strictly on preoperative parameters . DESIGN , SETTING , AND PARTICIPANTS Data of 679 bladder cancer ( BCa ) patients treated with RC at 18 institutions in 2011 were prospect ively collected , from which 597 patients were eligible for final analysis . INTERVENTION RC for BCa . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS An established prediction tool , the Isbarn nomogram , was applied to our cohort . For the purpose of external validation , model discrimination was measured using the receiver operating characteristics-derived area under the curve . Calibration plots examined the relationship between predicted and observed probabilities . Univariable and multivariable logistic regression models were fitted to assess the impact of preoperative characteristics on 90-d mortality . RESULTS AND LIMITATIONS The 30- , 60- , and 90-d mortality rates in the development cohort ( n=597 ) were 2.7 % , 6.7 % , and 9.0 % , respectively . The Isbarn nomogram predicted individual 90-d mortality with an accuracy of 68.6 % . Our preoperative multivariable model identified age ( odds ratio [OR]:1.052 ) , American Society of Anesthesiologists score ( OR : 2.274 ) , hospital volume ( OR : 0.982 ) , clinical ly lymphatic metastases ( OR : 4.111 ) , and clinical ly distant metastases ( OR : 7.788 ) ( all p<0.05 ) as independent predictors of 90-d mortality ( predictive accuracy : 78.8 % ) . Our conclusions are limited by the lack of an external validation of the preoperative model . CONCLUSIONS The Isbarn nomogram was vali date d with moderate discrimination . Our newly developed model consisting of preoperative characteristics might outperform existing models . Our model might be particularly suitable for preoperative patient counseling . PATIENT SUMMARY The current report vali date d an established nomogram predicting 90-d mortality in patients with bladder cancer after radical cystectomy ( RC ) .  We developed a new prediction tool consisting of strictly preoperative parameters , thus allowing clinicians an optimal consultation for RC c and i date
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 .