Skip to main content

Advertisement

SpringerLink
Log in

Impact of an oral nutrition protocol in patients treated with elective radical cystectomy: a long term follow-up

  • Short Research Report
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background After radical cystectomy, delayed return of bowel function is relatively common. Although studies investigating on the best modality for delivering nutritional support to this patient group are limited, parenteral nutrition was standard of care in those patients at the urological ward of the University Hospitals Leuven. In 2015, we published the findings from our study conducted in patients undergoing elective regular radical cystectomy at the urological ward of the University Hospitals Leuven comparing the length of hospital stay in patients with early postoperative parenteral nutrition (n = 48) versus an immediate oral nutrition protocol (n = 46). It was demonstrated that the implementation of an oral nutrition protocol was associated with a significant reduced length of hospital stay (median [IQR] of 18 [15–22] to 14 [13–18] days (p < 0.001)). The sample size was however too small to investigate the impact of the oral nutrition protocol on the incidence of catheter-related bloodstream infection, a common parenteral nutrition related complication. Objective To investigate the long term impact of an oral nutrition protocol on the incidence of catheter-related bloodstream infection, duration of catheterization and the length of hospital stay. Method Retrospectively, before (parenteral nutrition group) and after the implementation of the oral nutrition protocol (since March 10th 2010), two cohorts of 549 patients who underwent an elective regular radical cystectomy were included. The incidence of a catheter-related bloodstream infection and the length of stay were compared. A central venous catheter was present in every patient, which is standard of care. Results Catheter-related bloodstream infection was reduced from 22 (4%) to 10 (1.8%) (p = 0.031). The median duration of catheterization was 10 [7–13] days for the parenteral nutrition versus 7 [7–7] days for the oral nutrition group (p < 0.001). The median length of stay between both groups, 20 [17–25] before versus 17 [14–21] days after the implementation of the oral nutrition protocol, also differed significantly (p < 0.001). Implementing the oral nutrition protocol resulted in a parenteral nutrition associated cost saving of €470 per patient. Conclusion This large follow-up study showed that the oral nutrition protocol is associated with a reduction in catheter-related bloodstream infection. Besides, postponing parenteral nutrition in favour of oral nutrition enhances recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Barrass BJ, Thurairaja R, Collins JW, Gillatt D, Persad RA. Optimal nutrition should improve the outcome and costs of radical cystectomy. Urol Int. 2006;77(2):139–42.

    Article  CAS  Google Scholar 

  2. Hautmann RE, de Petriconi RC, Volkmer BG. 25 years of experience with 1000 neobladders: long-term complications. J Urol. 2011;185(6):2207–12.

    Article  Google Scholar 

  3. Svatek RS, Fisher MB, Williams MB, Matin SF, Kamat AM, Grossman HB, et al. Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy. Urology. 2010;76(6):1419–24.

    Article  Google Scholar 

  4. Adamakis I, Tyritzis SI, Koutalellis G, Tokas T, Stravodimos KG, Mitropoulos D, et al. Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion. Int Braz J Urol. 2011;37(1):42–8.

    Article  Google Scholar 

  5. Maffezzini M, Campodonico F, Canepa G, Gerbi G, Parodi D. Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus. Surg Oncol. 2008;17(1):41–8.

    Article  Google Scholar 

  6. Roth B, Birkhauser FD, Zehnder P, Thalmann GN, Huwyler M, Burkhard FC, et al. Parenteral nutrition does not improve postoperative recovery from radical cystectomy: results of a prospective randomised trial. Eur Urol. 2013;63(3):475–82.

    Article  Google Scholar 

  7. Maffezzini M, Gerbi G, Campodonico F, Parodi D. Multimodal perioperative plan for radical cystectomy and intestinal urinary diversion. I. Effect on recovery of intestinal function and occurrence of complications. Urology. 2007;69(6):1107–11.

    Article  Google Scholar 

  8. Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28(4):378–86.

    Article  CAS  Google Scholar 

  9. Pang KH, Groves R, Venugopal S, Noon AP, Catto JWF. Prospective implementation of enhanced recovery after surgery protocols to radical cystectomy. Eur Urol. 2017;73:363–71.

    Article  Google Scholar 

  10. Azhar RA, Bochner B, Catto J, Goh AC, Kelly J, Patel HD, et al. Enhanced recovery after urological surgery: a contemporary systematic review of outcomes, key elements, and research needs. Eur Urol. 2016;70(1):176–87.

    Article  Google Scholar 

  11. Daneshmand S, Ahmadi H, Schuckman AK, Mitra AP, Cai J, Miranda G, et al. Enhanced recovery protocol after radical cystectomy for bladder cancer. J Urol. 2014;192(1):50–5.

    Article  Google Scholar 

  12. Karl A, Buchner A, Becker A, Staehler M, Seitz M, Khoder W, et al. A new concept for early recovery after surgery for patients undergoing radical cystectomy for bladder cancer: results of a prospective randomized study. J Urol. 2014;191(2):335–40.

    Article  CAS  Google Scholar 

  13. Aning J, Neal D, Driver A, McGrath J. Enhanced recovery: from principles to practice in urology. BJU Int. 2010;105(9):1199–201.

    Article  Google Scholar 

  14. Declercq P, De Win G, Van der Aa F, Beels E, Van der Linden L, Van Poppel H, et al. Reduced length of stay in radical cystectomy patients with oral versus parenteral post-operative nutrition protocol. Int J Clin Pharm. 2015;37(2):379–86.

    Article  CAS  Google Scholar 

  15. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the infectious diseases society of America. Clin Infect Dis. 2009;49(1):1–45.

    Article  CAS  Google Scholar 

  16. Gavin NC, Button E, Keogh S, McMillan D, Rickard C. Does parenteral nutrition increase the risk of catheter-related bloodstream infection? A systematic literature review. JPEN J Parenter Enteral Nutr. 2017;41(6):918–28.

    Article  Google Scholar 

  17. Louie-Johnsun MW, Braslis KG, Murphy DL, Neerhut GJ, Grills RJ. Radical cystectomy for primary bladder malignancy: a 10 year review. ANZ J Surg. 2007;77(4):265–9.

    Article  Google Scholar 

  18. McCabe JE, Jibawi A, Javle P. Defining the minimum hospital case-load to achieve optimum outcomes in radical cystectomy. BJU Int. 2005;96(6):806–10.

    Article  Google Scholar 

  19. Malavaud B, Vaessen C, Mouzin M, Rischmann P, Sarramon J, Schulman C. Complications for radical cystectomy. Impact of the American Society of Anesthesiologists score. Eur Urol. 2001;39(1):79–84.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Krista D’Hondt for the help with queries to identify the elective RC patients from the databases provided by the Management Information and Reporting (MIR) and the positive blood cultures from the databases provided by the Laboratory Information System (LIS).

Funding

None to declare.

Conflicts of interest

No authors have financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.

Author information

Authors and Affiliations

  1. Pharmacy Department, University Hospitals Leuven, Louvain, Belgium

    Peter Declercq, Lutgart De Pourcq & Isabel Spriet

  2. Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Herestraat 49, 3000, Louvain, Belgium

    Peter Declercq, Lutgart De Pourcq & Isabel Spriet

  3. Department of Urology, University Hospitals Leuven, Louvain, Belgium

    Frank Van der Aa

  4. Department Development and Regeneration, Faculty of Medicine, KU Leuven, Louvain, Belgium

    Frank Van der Aa

Authors
  1. Peter Declercq
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frank Van der Aa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lutgart De Pourcq
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isabel Spriet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Declercq.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Declercq, P., Van der Aa, F., De Pourcq, L. et al. Impact of an oral nutrition protocol in patients treated with elective radical cystectomy: a long term follow-up. Int J Clin Pharm 41, 408–413 (2019). https://doi.org/10.1007/s11096-019-00800-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-019-00800-y

Keywords

Search

Navigation