%0 Journal Article
%T Impact of an enhanced recovery protocol in frail patients after intracorporeal urinary diversion.
%A Zennami K
%A Kusaka M
%A Tomozawa S
%A Toda F
%A Ito K
%A Kawai A
%A Nakamura W
%A Muto Y
%A Saruta M
%A Motonaga T
%A Takahara K
%A Sumitomo M
%A Shiroki R
%J BJU Int
%V 134
%N 3
%D 2024 Sep 19
%M 38500447
%F 5.969
%R 10.1111/bju.16340
%X <B>OBJECTIVE: </B>To determine whether an enhanced recovery after surgery (ERAS) protocol enhances bowel recovery and reduces postoperative ileus (POI) in both non-frail and frail patients after robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC).<BR><B>METHODS: </B>This retrospective cohort study included 186 patients (104 with and 82 without ERAS) who underwent iRARC between 2012 and 2023. 'Frail' patients was defined as those with a low Geriatric-8 questionnaire score (≤13). The primary outcomes were postoperative bowel recovery and the incidence of POI. Secondary outcomes included length of stay (LOS), 30- and 90-day complications, 90-day readmission rate, and POI predictors.<BR><B>RESULTS: </B>The ERAS group exhibited a significantly shorter LOS, early bowel recovery, a lower POI rate, fewer 90-day high-grade complications, and fewer 90-day readmissions than the non-ERAS group in the entire cohort. Non-frail patients in the ERAS group had a lower rate of POI (7.1% vs. 22.1%; P = 0.008), whereas ERAS did not reduce POI in frail patients (44.1% vs. 36.6%; P = 0.50). In the multivariate analysis, ERAS was associated with a reduced risk of POI in both the entire cohort (odds ratio [OR] 0.39, P = 0.01) and in non-frail patients (OR 0.24, P = 0.01), whereas ERAS was not likely to reduce POI (OR 1.14, P = 0.70) in frail patients. Prehabilitation was identified as a favourable predictor of POI.<BR><B>CONCLUSIONS: </B>The ERAS protocol did not reduce POI in frail patients after iRARC, although it enhanced bowel recovery and reduced POI in non-frail patients. Prehabilitation for frail patients might reduce POI.