Table 2 Study relevant information about enhanced recovery program for cystectomy patients at the University Department of Urology, Bern (Cystectomy Enhanced Recovery Approach (CERA ^© ))

Preoperative

No enteral bowel preparation

Two high enemas the evening before surgery

Normal nutrition till midnight before surgery

Clear drinks including carbohydrate till 2 h before surgery

Subcutaneous injection of low molecular heparin at 20:00 hours

Intraoperative

DVT prophylaxis with T.E.D.™ hose or sequential compression devices

Perioperative antibiotics 30 min before surgical incision

Restrictive fluid regimen aiming at zero postoperative weight gain

Gastrostomy tube placed, removal of orogastric tube at end of procedure

Postoperative

DVT prophylaxis with ambulation, T.E.D.™, and subcutaneous low molecular heparin (weight adapted), started 6 hours postoperatively

Chewing gum encouraged

Clear drinks allowed the same evening after surgery

Gastrostomy tube initially left on drainage; closure of the gastrostomy tube will occur when patient is without nausea and vomiting for >24 h

Bedside mobilization as soon as possible, ideally the same evening after surgery, but if this is not possible, not later than the next morning

Initial pain treatment with thoracic epidural analgesia, no opioids

GI ulcer prophylaxis with esomeprazole for at least the first 2 POD

Antibiotics for 48 hours

Ambulation on POD 1

Start oral fluids including energy drinks (Ensure®, Impact®) on POD 1

Unrestricted clear drinks on POD 1

Prokinetics: start with 0.5 mg neostigmin subcutaneously up to 4 times per day on POD 2

Small snacks introduced on POD 2, not later than POD 3

POD 3: encourage longer mobilization, walking distances, and spending time in a chair

Anti-emetics given only on request

Drains removed if draining <50 ml/day

Gastrostomy tube removed once the patient has passed stool

POD 5: thoracic epidural removed, oral analgesics (metamizole, paracetamol, hydroxycodon/naloxon (Targin®))