Time to change practice? Abstract Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer.
Despite improvements in surgical technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Enhanced recovery after surgery ERAS protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery.
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The key elements of ERAS protocols include preoperative counselling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization.
Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow.
The present article discusses particular aspects of ERAS protocols which represent fundamental shifts in surgical practice, including perioperative nutrition, management of postoperative ileus and the use of mechanical bowel preparation. Introduction Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer.
Although much of the data arise from colorectal surgery, the evidence is applicable to major urological surgery, in particular radical cystectomy. The introduction of ERAS in a centre in the United Kingdom lead to a significant reduction in hospital stay and equivalent morbidity in radical cystectomy patients, compared to traditional approaches.
Similar findings have been replicated in a small number of other urological publications.When there is a transcription delay, the Joint Commission requires the surgeon to document an operative: Condition of patient, unusual events, operative findings, specimens removed, procedure performed, preop/postop dx Characteristics of a well-functioning financial system The financial system plays a vital role in supporting sustainable economic growth and meeting the financial needs of Australians.
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