Optimizing radical cystectomy recovery: The role of modified ERAS in improving postoperative outcomes

Radical cystectomy (RC) is associated with high rates of postoperative complications and readmissions. Despite the adoption of enhanced recovery after surgery (ERAS) protocols, there was no reduction in our complications, prompting the development of a modified ERAS (M-ERAS) pathway at our institution. Here, we evaluated the impact of an M-ERAS, featuring tailored antibiotic prophylaxis, earlier stent removal at 2 weeks, and enhanced care coordination, on postoperative outcomes following RC.

We retrospectively reviewed an Internal Review Bord (IRB)-approved database of 306 patients who underwent RC with an ileal conduit between 2015 and 2024. Outcomes from patients treated with the M-ERAS protocol (n = 74) were compared to those from a prior cohort (n = 232). Multivariable logistic regression was used to assess the impact on overall complications, genitourinary (GU) infections, and readmissions at 30 and 90 days.

Patient demographics and comorbidities were similar between groups. The proportion of patients experiencing ≥1 complication at 90 days decreased following M-ERAS implementation (78.5% vs. 67.6%). Infectious complications were significantly reduced, driven by a decline in 30-day GU infections (35.3% vs. 12.2%, P ≤ 0.001). Readmissions due to GU infections also decreased at both 30 days (17.7% vs. 4.1%, P = 0.004) and 90 days (7.3% vs. 5.4%, P = 0.324). Adjusted analyses confirmed that M-ERAS was independently protective against GU infections at both 30 and 90 days.

A modified ERAS protocol incorporating targeted antibiotic prophylaxis and enhanced perioperative coordination was associated with fewer overall complications and a significant reduction in genitourinary infection-related readmissions after RC. These findings support the use of tailored, procedure-specific recovery pathways to improve outcomes for RC patients.