A clinical-care pathway for decreasing hospital stay after radical prostatectomy.
OBJECTIVE
To evaluate the use of a clinical-care pathway that decreased the stay in hospital after radical retropubic prostatectomy from 3 to 2 days, assessing the costs and quality of care.


METHODS
Forty-four consecutive men who underwent radical retropubic prostatectomy were evaluated prospectively. The first 22 men were hospitalized under the standard 3-day clinical-care pathway in use at our institution. This pathway was evaluated, shortened to construct a 2-day pathway, and a second group of 22 consecutive men hospitalized under the new pathway. Both groups were evaluated and compared 6 weeks post-operatively.


RESULTS
The mean (SD) hospital stay was 2.1 (0.3) days for men in the 2-day and 2.9 (0.4) days for men in the 3-day pathway (P < 0.001). The mean (SD) hospital cost was $8468 (801) in the 2-day and $8806 (630) in the 3-day pathway (P=0.13). None of the men in the 2-day and one of 22 men in the 3-day pathway experienced a major complication (P=0.31). Two of 22 men in the 2-day and one of 22 in the 3-day pathway exceeded the expected stay by one day (P=0.55).


CONCLUSIONS
The hospital stay after radical retropubic prostatectomy can be safely shortened from 3 to 2 days for most men. However, the shorter hospital stay does not result in significant cost savings. The shorter stay does not appear to compromise quality of care. Proper patient education and careful pre- and post-operative supervision are necessary for a successful outcome.
Keetch
D W
DW
Division of Urologic Surgery, Washington University School of Medicine and Barnes-Jewish West County Hospital, St Louis, Missouri, USA.
Buback
D
D
D000368:Aged; D002985:Clinical Protocols; D017721:Hospital Costs; D006801:Humans; D007430:Intraoperative Care / Q000191:economics; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D008923:Missouri; D011182:Postoperative Care / Q000191:economics; D011300:Preoperative Care / Q000191:economics; D011446:Prospective Studies; D011468:Prostatectomy / Q000191:economics / Q000379:methods*; D011471:Prostatic Neoplasms / Q000191:economics / Q000601:surgery*; D011787:Quality of Health Care