Radical cystectomy in a cohort of octogenarians managed in the ERAS era

Objectives: To describe contemporary perioperative outcomes for octogenarians managed under an Enhanced Recovery After Surgery (ERAS) protocol. ERAS protocols have improved outcomes in radical cystectomy (RC), though outcomes for octogenarian patients undergoing RC in the modern ERAS era are not well researched. ERAS components have been gradually implemented into our clinical care pathways over the past 10 years.

Methods and materials: Octogenarians undergoing RC at our institution were retrospectively identified between 2009 and 2019. Cox proportional hazards models examined changes in time to hospital discharge and time to bowel movement over time, and logistic regression models examined differences in 90-day readmissions and discharge dispositions over time. Secondary analyses examined the effect of alvimopan on time to hospital discharge and time to bowel movement using log-rank tests, along with 90-day readmissions and discharge dispositions using Chi-squared tests.

Results: Seventy octogenarian patients underwent RC during the study period. Median time to bowel movement was 6 days, while median time to hospital discharge was 9 days. Two-thirds of patients were discharged to home and 22% were readmitted within 90 days. There were no statistically significant associations between year of surgery and perioperative outcomes. Patients taking alvimopan had decreased time to hospital discharge (hazard ratio = 2.7, 95% confidence interval [1.5, 5.0], P = 0.002), but showed no difference in other perioperative outcomes.

Conclusions: Octogenarians treated with RC had no significant changes in perioperative outcomes during the implementation of ERAS components at our institution. However, octogenarians taking alvimopan were observed to have decreased time to hospital discharge.