Surgical approach as a determinant factor of clinical outcome following radical cystectomy: Does Enhanced Recovery After Surgery (ERAS) level the playing field?

Abstract Purpose To determine whether surgical approach is a determinant of clinical outcomes following radical cystectomy (RC) and urinary diversion when using an Enhanced Recovery After Surgery (ERAS) protocol. Materials and Methods We studied all patients undergoing both open radical cystectomy (ORC) and robotic-assisted radical cystectomy (RARC) and urinary diversion with ERAS for bladder urothelial carcinoma from May 2012 to December 2016. Surgical and clinical outcomes within 90 days after surgery were compared between ORC and RARC, including readmission and major complication rates (Clavien-Dindo grade ≥III). Multivariable logistic regression modeling was used to determine factors that predict readmission and major complications. Results A total of 345 and 143 patients underwent ORC and RARC, respectively. The ORC group had a greater proportion of continent urinary diversion (71.9 vs. 40.6%, P P P P = 0.002 and 20 vs. 11.9%, P = 0.04, respectively). Median length of stay was 4 days for ORC (interquartile range 4–6 days) and 6 days for RARC (interquartile range 4–7 days; P P = 0.51) or readmission rates (32.2 vs. 36.4%, P = 0.4) within 90 days after surgery. Multivariable logistic regression analysis showed that surgical approach was not an independent factor predictive of readmission ( P = 0.33) or major complications ( P = 0.76). Conclusions Surgical approach is not a determinant of readmission or major complications following RC in the context of an ERAS protocol.