Presentation Authors: Kai Wen Cheng*, Ankeet Shah, Nima Nassiri, Saum Ghodoussipour, Gus Miranda, Jie Cai, Anne Schuckman, Siamak Daneshmand, Hooman Djaladat, Los Angeles, CA
Introduction: Enhanced Recovery After Surgery (ERAS) protocols have mostly eliminated direct postoperative ICU admission following radical cystectomy (RC) for bladder cancer. However, high-grade complications may require transfers from non-ICU to ICU level of care and these transfers are not well studied. We report variables associated with ICU admission during index hospitalization after RC with ERAS protocol, as well as corresponding outcomes.
Methods: A retrospective review of an IRB-approved cystectomy database was conducted. Patients with adjuvant nephrectomy/urethrectomy and direct ICU admission following RC were excluded. Patients are presented in two groups based on ICU events in index hospitalization: 1) no ICU admission and 2) ICU transfer from non-ICU level of care.
Results: 505 patients who underwent RC with ERAS (intent to cure) were identified (2012-2017). Demographics and outcome data are summarized in Tables 1 and 2. ICU admission in index hospitalization was reported in 26 patients (5%) and led to a longer length of stay (LOS) for group 2 (p < 0.01). A higher age and Charlson Comorbidity Index (CCI) â‰¥3 were seen in group 2 (p=0.004, 0.01, respectively). ICU transfer and outcome data are summarized in Table 3. Patients in group 2 spent a median of 3 days (range: 0-32) at non-ICU level of care before transfer to the ICU; cardiac indications (48%) were the most common cause of transfer. A low rate of ICU admission (2.7%) in the corresponding 90-day postoperative period was reported for group 1.
Conclusions: ICU admission is uncommon following RC with ERAS protocol. Advanced age and comorbidity index are significantly associated with ICU transfer. Further analysis may allow for targeted care optimization to improve patient safety by reducing ICU admission rates.