title: Changes in perioperative management of radical prostatectomy using clinical pathways according to a standardized care plan: a multi-institutional study.
abstract: OBJECTIVE
  To improve the perioperative care for radical prostatectomy patients at a multi-institutional level and practice.
  
  
  METHODS
  A prospective multi-institutional study involving 50 hospitals was carried out in cooperation with the Japanese Society of Endourology. As the first step, a consensus meeting was held to establish a standardized perioperative care plan. Second, the clinical pathways were individually developed and revised according to the standardized care plan in each of the participating hospitals. Patterns of perioperative care, including preoperative hospital stay, resuming meals and ambulation, removal of pelvic drain and urethral catheter, antimicrobial administration, and postoperative hospital stay, were compared before (2007) and after developing/revising pathways (2009). Furthermore, actual practice and complications before and after implementing the pathways were investigated.
  
  
  RESULTS
  Except for resuming ambulation, all perioperative pathways were significantly shortened with the adoption of the newly defined clinical pathway (P < 0.001). Furthermore, all settings except for postoperative hospital stay significantly decreased in terms of variance (P < 0.002). In 2009, the overall complication rate significantly decreased (P < 0.001), and all of the outcomes except urethral catheter removal were also significantly shortened (P ≤ 0.008) and decreased in variance after implementation of the new pathways (P ≤ 0.006). In multivariate analyses, implementation of the refined clinical pathways was an important factor to improve perioperative care.
  
  
  CONCLUSIONS
  When standardized goals in perioperative care are recommended to hospitals and care plans are developed/revised in individual hospitals, both settings and practice are significantly improved. It is to be investigated whether a similar intervention could be useful to achieve a standardization of surgical pathway for other diseases.
authors.affiliation: Division of Urology, Department of Surgery and Intensive Care, National Center for Geriatrics and Gerontology, Obu, Japan. kokamura@toumei.hosp.go.jp
authors.forename: Kikuo
authors.initials: K
authors.lastname: Okamura
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Nojiri
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagae
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hattori
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hashine
authors.forename: Seiji
authors.initials: S
authors.lastname: Naito
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hasegawa
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D019091:Critical Pathways; D004322:Drainage; D004435:Eating; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014546:Urinary Catheterization; D016138:Walking
chemical_list: D000900:Anti-Bacterial Agents