The application of enhanced recovery after surgery (ERAS) protocol in radical cystectomy and urinary diversion using bowel segment reduces the length of stay: A multicenter comparative study in Indonesia

Introduction: Radical cystectomy is one of the most invasive urological procedures, with high difficulty and various complications. The Enhanced Recovery After Surgery (ERAS) protocol was created to improve patient outcomes after such surgery, including radical cystectomy. This study aims to evaluate the application of ERAS on radical cystectomy in Indonesia. Methods: This was a multicenter study (Jakarta, Yogyakarta, Bandung, and Medan) from July 2016 to April 2021. This study compared the postoperative length of stay, diet intake, bowel movement, and mobilization pattern of the subject receiving ERAS protocol with the non-ERAS subject. Curtailed, fast preoperative carbohydrate loading was administered to patients. There was no mechanical bowel preparation except one day before in selected cases. Postoperative patterns after surgery and the length of stay were analyzed. Results: We collected 128 subjects in this study, with 74 (60 %) subjects enrolled with ERAS protocol and 54 (40 %) with non-ERAS. There were statistically significant differences in length of stay with a median of 11 days vs. 16 (p: 0.001), intensive care unit admission duration with a median of 2 days vs. 3 (p: 0.004) and time to sit after radical cystectomy with a mean of 2.14 days vs 2.89 (p-: 0.004) in subject with ERAS protocol compared to non-ERAS protocol. Conclusion: This multicenter study found that ERAS was demonstrated to be efficacious in decreasing the duration of hospital stay, the duration of intensive care unit admission, and the time for the subject to sit after the radical cystectomy.