Category: Laparoscopic/ Robotic: Other

MP30-1 - The Implementation and Outcomes of a Targeted Global Perioperative Optimisation Platform using The Cystectomy Enhanced Preparation, Event and Recovery (C.E.P.E.R.) Pathway in a Robotic Cystectomy Programme

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

A structured and targeted global perioperative optimisation platform was developed in a bid to address 10 identified domains that were found to lead to “marginal gains” leading to reduced post-operative in hospital stay following Robot Assisted Radical Cystectomy (RARC). Our aim was to implement and test the platform entitled “The Cystectomy Enhanced Preparation, Event and Recovery (C.E.P.E.R.) Pathway in a high volume tertiary referral centre.”


Methods :

Three main sectors were identified (A) Enhanced Preparation (B) Event and (C) Enhanced Recovery. Each sector was further subdivided into Domains. Inclusion criteria, in this pilot study, included (1) [willingness of the patient to engage with all stipulated domains] and (2) [absence of severe psychiatric illness, severe immobility and known significant gastrointestinal disease]. Between December 2016 and August 2017, 15 patients were enrolled prospectively. Each patient was required to attend a preprocedural priming clinic. The “Event” or operative date had specific checklists including use of lignocaine infusion. Enhanced recovery was implemented by an intense multidisciplinary team based checklisted daily ward rounds. Following discharge, the patients were followed up on day 5 in a special support clinic.


Results :

A total of n=15 (M:F / 11:4) patients were enrolled. Median age 66.5yrs (range 47-73yrs). Mean ASA=1.9. Mean planned stay in ITU/HDU =1.9 days (range 1-3 days). Mean Clavien-Dindo Score=0.5 (range 0-2). Median postoperative stay was 4.25 days (range 4-8days). There were no readmissions and no postoperative mortalities reported. A review of 15 patients in the “pre-C.E.P.E.R. Pathway group” revealed a median postoperative stay of 16 days. The pathway thus reduced the postoperative stay by a factor of 4.


Conclusions : The implementation of a targeted global perioperative optimisation platform using The Cystectomy Enhanced Preparation, Event and Recovery (C.E.P.E.R.) Pathway has significantly reduced postoperative stay in a safe and effective manner. Large scale multicentre studies are currently being initiated to further evaluate similar pathways.

Sashi S. Kommu

Consultant Urological Surgeon
Canterbury Centre for Robotic Urological Surgery. East Kent Hospitals University NHS Foundation Trust.
Canterbury, England, United Kingdom

Paul H. Rouse

Consultant Urological Surgeon
Eastbourne District General Hospital. East Sussex Healthcare NHS Trust.
Eastbourne, England, United Kingdom

Rhian Edwards

Consultant Anaesthetist
Eastbourne District General Hospital. East Sussex Healthcare
Eastbourne, England, United Kingdom

Jocelyn Jaun

ERAS Nurse Specialist
Eastbourne District General Hospital. East Sussex Healthcare NHS Trust.
Eastbourne, England, United Kingdom

Abdoulai Samateh

Advanced Surgical Care Practitioner
Eastbourne District General Hospital. East Sussex Healthcare NHS Trust.
Eastbourne, England, United Kingdom

John Ireland

Pain Specialist
Eastbourne District General Hospital. East Sussex Healthcare NHS Trust.
Eastbourne, England, United Kingdom

Benjamin A. Eddy

Consultant Urological Surgeon
Canterbury Centre for Robotic Urological Surgery. East Kent Hospitals University NHS Foundation Trust.
Canterbury, England, United Kingdom

Edward H. Streeter

Consultant Urological Surgeon
Canterbury Centre for Robotic Urological Surgery. East Kent Hospitals University NHS Foundation Trust.
Canterbury, England, United Kingdom

Tim Larner

Consultant Urologist
Brighton & Sussex University NHS Foundation Trust
Hayward's Heath, England, United Kingdom

Peter D. Rimington

Consultant Urological Surgeon
Eastbourne District General Hospital. East Sussex Healthcare NHS Trust.
Eastbourne, England, United Kingdom