Safely reducing length of stay after open radical retropubic prostatectomy under the guidance of a clinical care pathway.
BACKGROUND
Collaborative care pathways have proven to be a safe and effective method of decreasing length of hospital stay (LOS) and costs after radical retropubic prostatectomy (RRP). In the current study, the authors evaluated the safety and efficacy of a pathway transitioning from a 3-day to a 2-day LOS.


METHODS
The authors performed a retrospective chart review of 994 patients who underwent RRP at the study institution between July 1994 and December 2001. A total of 561 patients were managed on a 3-day LOS pathway, 172 were managed during the transition period from 3 to 2 days, and 261 were managed on a 2-day LOS pathway. Statistical analysis was performed comparing preoperative variables and complications among the three groups.


RESULTS
No statistically significant differences were found in comparisons of preoperative and demographic variables including age, race, medical comorbidities, preoperative prostate-specific antigen level, clinical stage of disease at presentation, and biopsy Gleason score. Forty-nine of the 561 patients (8.7%) remained longer than their targeted 3-day LOS, whereas 14 of 261 patients (5.4%) were hospitalized for longer than their targeted 2-day LOS, a difference that approached statistical significance (P = 0.058). During the transition period, 99 of 172 patients (57.6%) were discharged on postoperative Day 2 and 73 patients (42.4%) were discharged on postoperative Day 3. Complication rates were found to be significantly lower (P = 0.013) in the 2-day LOS group (2.3%) compared with the 3-day LOS group (7.0%) and the transition group (8.1%). The rate of readmission remained constant at 3% during this time period.


CONCLUSIONS
Overall, greater than 90% of patients were discharged within 2-3 days of surgery with acceptable complication rates, suggesting that in a consistent patient population, the transition from a 3-day LOS to a 2-day LOS can be done successfully without compromising patient safety. Evaluation currently is ongoing with regard to a 1-day LOS.
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. sam.chang@vanderbilt.edu
Sam S
SS
Chang
Emily
E
Cole
Joseph A
JA
Smith
Roxelyn
R
Baumgartner
Nancy
N
Wells
Michael S
MS
Cookson
D000328:Adult; D000368:Aged; D019091:Critical Pathways; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies