Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: A prospective randomized controlled trial
- 25 September 2014
- journal article
- research article
- Published by Medical Journals Sweden AB in Scandinavian Journal of Urology
- Vol. 49 (2), 133-141
- https://doi.org/10.3109/21681805.2014.967810
Abstract
Introduction. Radical cystectomy with lymph-node dissection is a complex procedure and often followed by high postoperative morbidity and physical impairments leading to prolonged length of stay (LOS). Fast-track principles are standard procedure in radical cystectomy. Additional preoperative and postoperative physical exercises and enhanced mobilization may reduce LOS and early complications. Materials and methods. In total, 107 patients were included in a prospective randomized controlled design, 50 in the intervention group (n(I) = 50) and 57 in the standard group (n(s) = 57). The standard regimen comprised regular fast-track principles. The intervention included standardized preoperative and postoperative strength and endurance exercises and progressive postoperative mobilization. The programme was initiated 2 weeks before surgery. Efficacy was expressed as a reduction in postoperative LOS. Early complications were defined as events occurring at most 90 days postoperatively and graded using the Clavien-Dindo classification system. Results. Adherence to prehabilitation, i.e. patients who accomplished at least 75% of the programme, was 59%. Postoperative mobilization was significantly improved by walking distance (p <= 0.001). The ability to perform personal activities of daily living was improved by 1 day (p <= 0.05). The median LOS was 8 days in both treatment groups (p = 0.68). There was no significant difference between treatment groups in severity of complications (p = 0.64). Conclusions. There was no reduction in LOS due to the preoperative and postoperative rehabilitation programme, although enhanced mobilization was achieved. The optimized minimal surgical procedure may have affected the ability to reduce LOS further with available techniques and procedures. Alternative parameters for recovery may offer more precise and relevant information.Keywords
This publication has 28 references indexed in Scilit:
- A systematic review of pre-surgical exercise intervention studies with cancer patientsSurgical Oncology, 2013
- Prospective, randomized study of ropivacaine wound infusion versus intrathecal morphine with intravenous fentanyl for analgesia in living donors for liver transplantationLiver Transplantation, 2013
- Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendationsClinical Nutrition, 2012
- Disparities in bladder cancerUrologic Oncology, 2012
- Effect of Preoperative Nutritional Deficiency on Mortality After Radical Cystectomy for Bladder CancerJournal of Urology, 2011
- Evidence Basis for Regional Anesthesia in Multidisciplinary Fast-Track Surgical Care PathwaysRegional Anesthesia & Pain Medicine, 2011
- Randomized clinical trial of prehabilitation in colorectal surgeryBritish Journal of Surgery, 2010
- Stool Form Scale as a Useful Guide to Intestinal Transit TimeScandinavian Journal of Gastroenterology, 1997
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987