Enhanced Recovery Protocol Reduces Postoperative Infections After Robotic-Assisted Radical Cystectomy

In a significant development in the field of urology, the implementation of an enhanced recovery after surgery (ERAS) protocol has led to a substantial reduction in postoperative infections following robotic-assisted radical cystectomy (RARC). Despite the significant improvements in morbidity associated with RARC, infectious complications, including sepsis, urinary tract infections (UTIs), wound infections (WIs), and intra-abdominal infections (AIs), have remained a concern.

Researchers conducted a retrospective analysis of patients undergoing RARC between 2014 and 2022 at a tertiary care institution, categorizing them into two groups based on adherence to a modified ERAS protocol. The modified ERAS group included intracorporeal urinary diversion (ICUD) and antibiogram-directed antimicrobial prophylaxis, while the unmodified ERAS group followed extracorporeal urinary diversion (UD) and guideline-recommended prophylaxis.

The study aimed to assess the impact of these protocol modifications on infection rates post-surgery.

The analysis involved 396 patients, with the modified-ERAS group comprising 258 patients and the unmodified-ERAS group comprising 138 patients. The modified-ERAS group showed a significant reduction in the rates of both 30-day and 90-day UTIs as well as 30-day wound infections.Multivariate regression analysis confirmed that the modified-ERAS protocol was associated with a significantly lower risk of UTIs and WIs.

Ref: Antibiogram-directed Prophylaxis and Intracorporeal Urinary Diversion for Robot-assisted Radical Cystectomy, Jordan M. Rich et al,European Urology Focus