PD50: Bladder Cancer: Epidemiology & Evaluation II
PD50-01: Impact of Weekly Multidisciplinary Team Meeting in Implementing Pathways on Early Perioperative Outcomes after Robot-Assisted Radical Cystectomy: A Matched Analysis
Friday, May 15, 2020
7:00 AM – 9:00 AM
Naif Aldhaam, Ahmed Elsayed, Ahmed Hussein, Zhe Jing, Jennifer Osei, Mohammad Durrani, Tarik Babar, Alat Siam, Brett Hull, Deniz Demirbas , Michelle Graton, Therese Kurtz, Teresa Johnson, Stefanie Rowan, Carolyn Miller, Qiang Li, Khurshid Guru
Introduction: Our “NEEW cystectomy pathway” (Nutrition, Exercise, patient Education and Wellness) was implemented through a dedicated weekly multidisciplinary team meeting to coordinate and actively engage with patient care during the perioperative period (Table 1). We sought to investigate the effect of incorporation of this weekly meeting implementing NEEW pathway on perioperative outcomes after robot-assisted radical cystectomy (RARC).
Methods: We retrospectively reviewed our prospectively maintained cystectomy database. Patients were divided into 2 groups: those who were enrolled in the NEEW cystectomy pathway managed by a multidisciplinary weekly team meeting, versus those in the pre-pathway era. Propensity score matching was performed for both groups in terms of patient and disease characteristics in 1:2 ratios. Perioperative outcomes were compared. Multivariate analyses were modeled to assess for association between the dedicated team meeting and perioperative outcomes.
Results: 64 patients (33%) in the dedicated team meeting with NEEW pathway group vs. 128 patients (67%) in pre-pathway era. The team meeting group patients had shorter mean inpatient stay (6 vs 7 days, p<0.01), faster return of bowel function (3 vs 4 days, p < 0.01), and significantly better pain scores on the first three days after RARC (p < 0.01). They demonstrated fewer 30-day high grade complications (5% vs 16%, p=0.02), but similar readmissions (p=0.11). On multivariate analysis models, the weekly meeting using the NEEW pathway was associated with a shorter hospital stay (p= 0.01), faster return of bowel function (p<0.01), longer functional mobility time after RARC (p<0.01) and less pain score after RARC (p<0.01) (Table 1).
Conclusions: A dedicated multidisciplinary team meeting using the NEEW pathway was associated with improved short-term perioperative outcomes after RARC. Source of