Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
University of Bologna, Bologna, Italy.
Minerva Urol Nephrol. 2021 Dec;73(6):763-772. doi: 10.23736/S2724-6051.20.03843-6. Epub 2020 Nov 17.
We aimed at comparing perioperative outcomes in patients submitted to radical cystectomy followed by Fast Track (FT) protocol or standard management, and propose a definition of Trifecta, to improve standardized quality assessment for RC.
We considered 191 patients submitted to RC between January 2017 and January 2019. Patients followed FT or standard management according to surgeon's preference. Preoperative and intraoperative characteristics, alongside with postoperative outcomes were compared between the two groups. Trifecta was defined as follows: in-hospital stay (HS) ≤ 10 days, time to defecation (TtD) below the overall mean and no major (≥ Clavien-Dindo grade III) complications. Finally, Trifecta achievement rates were assessed in both groups.
Seventy-five patients (39%) followed the FT protocol and 116 (61%) standard management. The two groups were homogeneous for preoperative, intraoperative and pathological characteristics. Patients in the FT group had shorter TtD (5 vs. 6 days P=0.006), HS (12 vs. 14 days P=0.008) and lower readmission rate (8% vs. 19% P=0.04). Early complication rates and grades were similar, while less late complications were found in FT group (6.7% vs. 21.6% P=0.006). Trifecta achievement rate was higher for FT group (31% vs. 8% P<0.001). Single-item failure percentages for HS, TtD and major grade complications were respectively 90%, 60% and 19%, with no difference between the two groups.
FT protocol can safely consent faster bowel recovery and earlier discharge after RC, plus reducing readmission rates. Using a Trifecta incorporating essential perioperative outcomes, could improve standardized quality assessment for RC.
我们旨在比较接受根治性膀胱切除术（RC）后接受快速通道（FT）方案或标准管理的患者的围手术期结果，并提出 Trifecta 的定义，以提高 RC 的标准化质量评估。
我们考虑了 191 例于 2017 年 1 月至 2019 年 1 月接受 RC 的患者。根据外科医生的偏好，患者接受 FT 或标准管理。比较两组患者的术前和术中特征以及术后结果。Trifecta 定义如下：住院时间（HS）≤10 天，排便时间（TtD）低于总体平均值，无主要（≥Clavien-Dindo 分级 III 级）并发症。最后，评估两组患者的 Trifecta 达成率。
75 例（39%）患者遵循 FT 方案，116 例（61%）患者接受标准管理。两组患者的术前、术中及病理特征均具有可比性。FT 组患者的 TtD 更短（5 天比 6 天，P=0.006）、HS 更短（12 天比 14 天，P=0.008）、再入院率更低（8%比 19%，P=0.04）。早期并发症的发生率和严重程度相似，而 FT 组的晚期并发症较少（6.7%比 21.6%，P=0.006）。FT 组的 Trifecta 达成率更高（31%比 8%，P<0.001）。HS、TtD 和主要并发症的单项目失败百分比分别为 90%、60%和 19%，两组之间无差异。
FT 方案可安全地促进 RC 后更快的肠道恢复和更早的出院，同时降低再入院率。使用包含基本围手术期结果的 Trifecta，可以提高 RC 的标准化质量评估。
