Complications after surgery a “hidden pandemic” for health services
Prof. John Kelly (London, GB) highlighted the economic aspects of suboptimal pre- and postoperative care for patients at the conclusion of the Plenary Session on the patient journey on the final day of EAU25 in Madrid. His talk followed a series of speakers who presented and debated all aspects of patient ‘prehabilitation’ to rehabilitation. The session was chaired by Prof. James Catto (Sheffield, GB) and Prof. Kari Tikkinen (Helsinki, FI).
A lot of progress can yet be made in complication prevention and treatment, Prof. Kelly pointed out, with some studies showing 20% of patients who underwent a cystectomy had post-surgery complications, 70% of whom were re-admitted to hospital. Patients saw a 39% increase in healthcare utilisation days in the two years after surgery, making unplanned readmission and complications a significant economic factor as well.
The first part of the session started with the fictional case presentation of elderly bladder cancer patient Anne by Dr. Stine Hedegaard Reeler (Roskilde DK). At age 73, with a prior history of lung cancer, and her rapid weight loss, the treatment was changed from cystectomy to radiotherapy due to her frail condition. Her condition and possible treatment path was the thread for the discussions on prevention of thrombosis and infections, multi-morbidity and frailty, as well as the current state of the adoption and adherence to the Enhanced Recovery After Surgery (ERAS) protocol.
Low-hanging fruit
Dr. Sarah Psutka (Seattle, USA) examined some of the major barriers and also facilitators of exercise for patients with urological cancer or other major illnesses. A significant barrier is a lack of specific exercise instruction from providers. Taking “exercise as medicine” to the next level, Dr. Psutka said to have achieved good results by writing an actual exercise prescription, with a “dose”, “frequency” and potential side-effects to watch for: “By making it as specific and concrete as possible, patients adhere to it better.”
Dr. Psutka also pointed to the trend of increased use of digital health, allowing patients to exercise in and around their homes while still being monitored and if necessary encouraged or reached out to by the team in case the patient was struggling. Key concerns for the physicians were how digitally savvy the elderly were, but with an extremely large majority of the (American) over-60 populace owning and using smart devices, they are willing and able to use them to aid their prehabilitation exercises.
In the discussion that followed, the issue was raised that beyond the initial recommendations, the real challenge was to get patients to continue with their exercise regimen, and nudges and encouragement through remote monitoring could be an important aspect of that. Dr. Karl-Friedrich Kowalewski (Mannheim, DE) also pointed out that it’s important to not aim too high, but that it was important to at least pick the “low-hanging fruit” in getting patients in the best condition before or after their surgery.