MP26-14 MEASURING SUCCESS AFTER RADICAL CYSTECTOMY: FEASIBILITY OF A NOVEL COMPOSITE ENDPOINT (“POOR RECOVERY”) TO QUANTIFY OUTCOMES AFTER SURGERY (2015)

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2015MP26-14 MEASURING SUCCESS AFTER RADICAL CYSTECTOMY: FEASIBILITY OF A NOVEL COMPOSITE ENDPOINT (“POOR RECOVERY”) TO QUANTIFY OUTCOMES AFTER SURGERY Erika L. Wood, Janet E. Baack Krukreja, Sima Porten, Wei Qiao, Raphael Ezeagu, Neema Navai, Ashish M. Kamat, Colin P. Dinney, and Jay B. Shah Erika L. WoodErika L. Wood More articles by this author , Janet E. Baack KrukrejaJanet E. Baack Krukreja More articles by this author , Sima PortenSima Porten More articles by this author , Wei QiaoWei Qiao More articles by this author , Raphael EzeaguRaphael Ezeagu More articles by this author , Neema NavaiNeema Navai More articles by this author , Ashish M. KamatAshish M. Kamat More articles by this author , Colin P. DinneyColin P. Dinney More articles by this author , and Jay B. ShahJay B. Shah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1136AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Given the predilection of invasive bladder cancer toward older sicker patients and the complexity of radical cystectomy (RC), it is not surprising many patients experience prolonged, difficult recoveries after surgery. There is growing interest in identifying ways to improve recovery after RC. To date, studies on this topic have focused on inpatient length of stay (LOS) as the primary outcome measure. Given that many patients suffer complications after discharge and require readmission to the hospital, LOS may not be the most useful measure to determine efficacy of recovery improvement efforts. We propose a novel composite endpoint – “Poor Recovery” – as a more encompassing measure of outcomes after RC. METHODS A comprehensive perioperative multidisciplinary algorithm called the Optimized Surgical Journey (OSJ) has been in development at our institution over the last 18 months. We selected 50 patients who underwent RC with the OSJ algorithm and 50 patients who underwent RC with usual care during the same time period. Poor Recovery was defined by inpatient LOS > 7 days or hospital readmission within 30 days. Statistical analyses included the Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables. RESULTS Patients in the OSJ group had significantly shorter times to flatus, bowel movement, first ambulation and resumption of regular diet as compared to the Non-OSJ group (Table). There were no differences between the groups in operative time, blood loss, analgesia or rate of ICU admission. Mean LOS was significantly shorter in the OSJ group (5.6 vs. 8.5 days, p < 0.01). Poor Recovery was experienced by 18% of patients in the OSJ group and 60% of patients in the Non-OSJ group (p < 0.01). CONCLUSIONS We define a novel composite endpoint – Poor Recovery – that can help measure outcomes after RC. For future prospective studies of accelerated recovery pathways, the poor recovery endpoint may be a useful metric by which to determine the efficacy of various interventions. Table 1. Post-Operative Recovery OSJ Non-OSJ P-Value Recovery - mean POD (SD) Ambulation 1.3 (0.5) 1.9 (1.4) 0.01 Flatus 2.9 (1.3) 4.3 (1.4) < 0.01 Bowel movement 3.8 (1.4) 5.2 (1.6) < 0.01 Regular diet 3.4 (1.5) 6.5 (3.2) < 0.01 Length of stay 5.6 (1.5) 8.5 (4) < 0.01 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e298-e299 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erika L. Wood More articles by this author Janet E. Baack Krukreja More articles by this author Sima Porten More articles by this author Wei Qiao More articles by this author Raphael Ezeagu More articles by this author Neema Navai More articles by this author Ashish M. Kamat More articles by this author Colin P. Dinney More articles by this author Jay B. Shah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...