Abstract:
OBJECTIVE:To describe and assess the evolution of an enhanced recovery programme (ERP) for open radical cystectomy. PATIENTS AND METHODS:We introduced a mentored ERP for radical cystectomy in January 2011. The programme underwent service evaluation and multiple changes in August 2012 that we define as marginal gains. We present a retrospective review of 133 consecutive patients undergoing open radical cystectomy, grouped according to the three stages of the ERP from October 2008 to April 2013: (1) non-ERP group (October 2008 to December 2010): n = 69; (2) ERP-1 group (January 2011 to July 2012): n = 37; and (3) ERP-2 group (August 2012 to April 2013): n = 27. Primary outcomes were length of hospital stay (LOS), readmission, morbidity at 90 days using the Clavien classification system and mortality. Secondary outcomes were time to flatus, ileus rates, re-operation rates and oncological outcomes. RESULTS:There were no differences in patient demographics among any of the groups for: age, gender, BMI, American Society of Anesthesiologists score and the use of neoadjuvant chemotherapy. There were no differences in readmission, morbidity and mortality rates. The overall 90-day mortality was six patients (4.5%). There were significant differences in ileus rates between the non-ERP, the ERP-1 and the ERP-2 groups: 44.9% (31 patients), 29.7% (11 patients) and 14.8% (four patients), respectively (P = 0.017). There was a significant difference in the presence of pathological lymphadenopathy in the ERP-2 group: non-ERP group, 10.1%; ERP-1 group, 16.2%; and ERP-2 group, 44.4%; P = 0.002. There was also a difference in the mean (sd) lymph node yield in ERP-2: non-ERP group, 8.4 (5.4) nodes; ERP-1, 8.2 (6.4) nodes; and ERP-2, 16.7 (5.4) nodes (P < 0.001). The median (range) LOS was 14 (7-91) days, 10 (6-55) days and 7 (3-99) days in the non-ERP, ERP-1 and ERP-2 groups, respectively (P < 0.001). CONCLUSIONS:Auditing an already successful ERP and implementing a number of marginal gains has led to a significant decrease in the median LOS for radical cystectomy. The LOS for open radical cystectomy at University Hospital Southampton has halved. In the second phase of our ERP, our median LOS is 7 days.
journal_name
BJU Intjournal_title
BJU internationalauthors
Smith J,Meng ZW,Lockyer R,Dudderidge T,McGrath J,Hayes M,Birch Bdoi
10.1111/bju.12644subject
Has Abstractpub_date
2014-09-01 00:00:00pages
375-83issue
3eissn
1464-4096issn
1464-410Xjournal_volume
114pub_type
杂志文章abstract:OBJECTIVE:To assess the long-term outcome of forearm free-flap phalloplasty in transsexuals, as obtaining a satisfying neophallus in female-to-male transsexuals is a surgical challenge. PATIENTS AND METHODS:We analysed retrospectively 56 transsexuals who had a phalloplasty using a radial forearm free-flap in our depar...
journal_title:BJU international
pub_type: 杂志文章
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abstract:OBJECTIVES:To determine the feasibility and efficacy of suicide-gene therapy using adenovirus (Ad)-mediated herpes simplex virus thymidine kinase (HSV-TK) and the prodrug acyclovir, and to evaluate changes in the biological phenotype for tumour cell proliferative activity after suicide-gene therapy in animal models of ...
journal_title:BJU international
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doi:10.1046/j.1464-410x.2000.00516.x
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pub_type: 杂志文章
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1046/j.1464-410x.2000.00547.x
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2008.07584.x
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2005-05-01 00:00:00
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pub_type: 杂志文章
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更新日期:2003-08-01 00:00:00
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pub_type: 杂志文章
doi:10.1111/j.1464-410X.2006.06010.x
更新日期:2006-02-01 00:00:00
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pub_type: 杂志文章
doi:10.1046/j.1464-410x.2002.02776.x
更新日期:2002-06-01 00:00:00
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pub_type: 杂志文章
doi:10.1111/j.1464-410x.2003.04674.x
更新日期:2004-03-01 00:00:00
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pub_type: 杂志文章
doi:10.1111/j.1464-410X.2007.07198.x
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pub_type: 杂志文章
doi:10.1111/j.1464-410X.2007.07115.x
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pub_type: 杂志文章
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pub_type: 杂志文章
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doi:10.1111/bju.13248
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pub_type: 杂志文章,评审
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更新日期:2013-05-01 00:00:00
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doi:10.1111/j.1464-410X.2011.10848.x
更新日期:2012-09-01 00:00:00
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更新日期:2016-06-01 00:00:00
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更新日期:2000-05-01 00:00:00
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pub_type: 杂志文章
doi:10.1111/j.1464-410x.2004.04567.x
更新日期:2004-01-01 00:00:00
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更新日期:2002-05-01 00:00:00
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更新日期:2010-09-01 00:00:00