Results from the ERAS for Ambulatory TURBT: Enhancing Bladder Cancer Care (EMBRACE) Randomized Controlled Trial.

Abstract

Transurethral resection of a bladder tumor (TURBT) contributes to morbidity of patients with bladder cancer. This trial evaluates the impact of an enhanced recovery after surgery (ERAS) protocol on quality of recovery from ambulatory TURBT. In a prospective, single institution randomized controlled trial, patients undergoing ambulatory TURBT were randomized to ERAS (including preoperative patient education, intraoperative and postoperative anesthesia/surgery interventions) or usual care, January 2024-May 2024. The primary end point was the mean difference in Quality of Recovery 15 (QoR-15) score (0-150, higher is superior recovery) between groups over day of surgery (DOS) and postoperative day 1 (POD1). Secondary end points included urinary tract infection-symptom impairment questionnaire (UTI-SIQ-8), pain scores, and incontinence rates on POD1. Patients were randomized in a 1:1 ratio to ERAS (n = 50) or usual care (n = 50). On multivariable analysis, the mean QoR-15 was 12 points higher in ERAS group vs controls for day of surgery and POD1, 137 vs 125, respectively (<i>P</i> < .001). UTI-SIQ-8 was lower in the ERAS group vs control: 5.8 vs 12, <i>P</i> < .001. ERAS patients experienced reduced urethral pain (2.4 vs 4, <i>P</i> < .01), penile/vulvar pain (1.3 vs 2.7, <i>P</i> < .01), dysuria (2.6 vs 4.4, <i>P</i> < .001), and urinary incontinence (14% vs 41%, <i>P</i> = .02) vs controls. Utilization of ERAS for ambulatory TURBT significantly improves quality of recovery for patients with bladder cancer undergoing this common procedure.