International Journal of Clinical Pharmacy

, Volume 37, Issue 2, pp 379–386 | Cite as

Reduced length of stay in radical cystectomy patients with oral versus parenteral post-operative nutrition protocol

  • Peter DeclercqEmail author
  • Gunter De Win
  • Frank Van der Aa
  • Beels Elodie
  • Lorenz Van der Linden
  • Hendrik Van Poppel
  • Willems Ludo
  • Spriet Isabel
Research Article


Background In Europe, parenteral nutrition is often used after radical cystectomy to avoid postoperative malnourishment. To the best of our knowledge, however, there is a paucity of data to conclude on the best modality for delivering nutritional support to this patient group. Objective The parenteral nutrition policy was reconsidered and an oral nutrition protocol was implemented by the clinical pharmacist and evaluated in terms of length of stay, number and type of postoperative complications and parenteral nutrition avoided costs. Setting A prospective interventional non-randomized before-after study was conducted. Regular radical cystectomy patients presenting without preoperative contra-indications for enteral nutrition were eligible. Methods Postoperatively, in the control group, the parenteral nutrition policy from the ward was applied. Parenteral nutrition was initiated systematically and continued until the patient was able to tolerate solid food. In the interventional group, an oral nutrition protocol was implemented. Parenteral nutrition could be initiated if oral intake remained insufficient after 5 days. Main outcome measure The primary end point was postoperative length of stay. Secondary endpoints included the number of patients in whom the oral nutrition protocol was implemented successfully, as well as the number and type of postoperative complications. Results A total of 94 eligible patients was assigned consecutively to the control (n = 48) and to the interventional group (n = 46). Baseline demographics were comparable. A significant reduction in median length of stay was associated with the oral nutrition protocol [18 days (IQR 15–22) in the control group vs. 14 days (IQR 13–18) in the interventional group (p < 0.001)]. In 40 out of 46 patients from the interventional group, the oral nutrition protocol was implemented successfully. The number and type of postoperative complications did not differ significantly. Implementing the oral nutrition protocol resulted in a direct parenteral nutrition infusion bag cost saving of approximately €512 and a reduction in hospitalization cost of €2,608 per patient. Conclusion The findings of our study showed that an oral nutrition protocol, when compared to the systematic postoperative use of parenteral nutrition, was associated with a decreased length of stay and costs in a regular radical cystectomy patient population.


Belgium Costs Length of stay Oral nutrition 



Colony forming units


Catheter related blood stream infection


Enteral nutrition


Oral nutrition protocol


Postoperative ileus


Postoperative complications


Parenteral nutrition


Radical cystectomy




Conflicts of interest

The authors declare no conflicts of interest.


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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Peter Declercq
    • 1
    • 2
    Email author
  • Gunter De Win
    • 3
    • 4
    • 5
  • Frank Van der Aa
    • 3
    • 4
  • Beels Elodie
    • 3
    • 4
  • Lorenz Van der Linden
    • 1
    • 2
  • Hendrik Van Poppel
    • 3
    • 4
  • Willems Ludo
    • 1
    • 2
  • Spriet Isabel
    • 1
    • 2
  1. 1.Pharmacy DepartmentUniversity Hospitals LeuvenLeuvenBelgium
  2. 2.Department of Pharmaceutical and Pharmacological SciencesKU LeuvenLeuvenBelgium
  3. 3.Department of Urology, Faculty of MedicineUniversity Hospitals LeuvenLeuvenBelgium
  4. 4.Department Development and RegenerationKU LeuvenLeuvenBelgium
  5. 5.Department of Urology, Faculty of MedicineUniversity Hospital AntwerpAntwerpBelgium

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