Effective analgesia and decreased length of stay for patients undergoing radical prostatectomy: Effectiveness of a clinical pathway.
OBJECTIVE
To assess the impact of a clinical pathway (CP) on length of stay (LOS), complications, readmission rates, and patient satisfaction for patients undergoing a radical retropubic prostatectomy (RRP).


METHODS
A standardized CP for all patients undergoing RRP was developed and implemented. Post-operatively, patients enrolled in the CP received oral ibuprofen and acetaminophen analgesia, with oral and subcutaneous narcotics available for breakthrough pain. Patients enrolled in the CP were compared to a pre-CP historical cohort. Patients were asked to complete a short, validated satisfaction questionnaire 10 days post-operatively.


RESULTS
Sixty-eight consecutive patients underwent a RRP following CP implementation and were compared to a historical cohort of 147 pre-CP patients. Median LOS decreased by 50% (4 days versus 2 days, p < 0.0001) while complication and readmission rates were unchanged. Patient satisfaction was high in all domains. Overall, 29.4% of patients treated within the CP required no narcotic analgesia during their admission.


CONCLUSIONS
The implementation of a CP for patients undergoing a RRP is a simple and effective method for reducing LOS without compromising complication, readmission rates or patient satisfaction.
McLellan
R Ashley
RA
Department of Urology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Bell
David G
DG
Rendon
Ricardo A
RA
D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D019091:Critical Pathways; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011795:Surveys and Questionnaires