The Importance of a Multidisciplinary Approach for Radical Cystectomy: The GRACE-M Project

<sec><title>Backgrounds</title> ERAS protocols result in inadequate assessment of comorbidities and frailties. In this study we analyze a new multidisciplinary clinical pathway inspired by the ERAS protocols, the GRACE-M project (designed for patients requiring Radical Cystectomy and focused on frailties and nutritional status), comparing these patients to a population of Radical Cystectomy patients not enrolled in this pathway. </sec><sec><title>Methods</title> This study is a comparison between a group of patients enrolled in the GRACE-M pathway, a single-center ongoing prospective cohort study, and a group of patients who received Radical Cystectomy without being recruited in the pathway. We did a non-randomized pre–post cohort study. The primary outcome was complications’ rate at 30 and 90 days and their severity, the secondary outcomes were mortality and readmission rate. We performed a multinomial logistic regression to evaluate the differences in outcomes between the two groups. </sec><sec><title>Results</title> Overweight patients were more likely to have complications at 30 days (OR 2.39, <italic>P</italic>-value 0.04). Female patients (OR 0.06, <italic><italic>P</italic></italic>-value 0.02) and GRACE-M patients (OR 0.1, <italic>P</italic>-value 0.01) had reduced odds to experience a major complication (Clavien-Dindo&gt;2) at 90 days. The main limitations of the study can be found in the limited number of patients and the difference between the enrollment of the two groups, since the control group is made of patients who underwent Radical Cystectomy prior to the initiation of the GRACE-M protocol. </sec><sec><title>Conclusion</title> In this study we analyzed a new multidisciplinary pathway for Radical Cystectomy. Our findings support the adoption of the GRACE-M protocol for candidates for Radical Cystectomy, especially due to a reduced risk of a major complication at 90 days. This article can serve as a starting point for further exploration of this topic. </sec>