Association of ERAS protocol adherence with complications and readmissions following open radical cystectomy: a pilot study from an ERAS Society-qualified centre.

OBJECTIVES: This pilot study evaluated the association between Enhanced Recovery After Surgery (ERAS) protocol adherence and postoperative outcomes following open radical cystectomy (RC), with a focus on complications and readmissions. METHODS: The ERAS® RC pathway (20 strongly recommended items) was implemented at our ERAS®-qualified center (AO Santa Croce e Carle) from October 2019. Prospective perioperative data were collected for the first 100 consecutive patients. No non-ERAS or historical control group was included. The outcomes included in-hospital and 30-day complications, readmissions within 30 days, and readmissions occurring between postoperative days 31 and 90. Postoperative ERAS adherence ≥70% was defined as good postoperative compliance. Logistic regression assessed associations between adherence and outcomes. The primary endpoint was the association between ERAS adherence and early complications; the secondary endpoint was readmission occurring between postoperative days 31 and 90 and its potential predictors. RESULTS: Most patients were male (88%), with a mean age of 72.2 ± 7.9 years; 95% underwent RC for oncologic indications. Mean length of stay (LOS) was 10.5 ± 7.1 days. Within 30 days, 65% experienced complications, predominantly Clavien-Dindo grade II; urinary tract infections were the most frequent (40%). Seventeen patients (17%) were readmitted within 30 days and 12 patients (12%) experienced at least one readmission between postoperative days 31 and 90. Because seven patients were readmitted during both intervals, the cumulative 90-day readmission rate was 22%. ERAS adherence was high preoperatively (95.5%) and intraoperatively (99.2%), but lower postoperatively (65.8%). Adherence ≥70% was significantly associated with shorter LOS (p=0.001) and fewer 30-day complications (p=0.012). In multivariable models, higher postoperative ERAS adherence remained independently associated with lower odds of in-hospital (p=0.0004) and 30-day complications (p=0.001). No significant association was observed between the ≥70% adherence threshold and readmissions occurring between postoperative days 31 and 90. CONCLUSIONS: Higher postoperative ERAS adherence was independently associated with fewer early complications and a shorter length of stay among patients undergoing open radical cystectomy within an established ERAS pathway. These findings support the clinical relevance of structured ERAS delivery with continuous adherence monitoring and warrant multicenter validation across both open and minimally invasive approaches.