title: Ambulatory pathway laser prostate surgery in severely ill patients--feasibility and short-term outcomes.
abstract: OBJECTIVE
  To assess readmissions, complications, and outcomes of a rapid ambulatory discharge pathway (RADP) in high anesthetic risk patients who have undergone laser prostate surgery.
  
  
  METHODS
  Medical records of patients who underwent holmium laser ablation of the prostate between 2007 and 2012 by a single surgeon were retrospectively reviewed. Patients with American Society of Anesthesiologists category ≥3 ("severe systemic disease") were included. All patients were scheduled for a rapid ambulatory discharge pathway, which involved discharge on the day of surgery with a urethral catheter, with a voiding trial on postoperative day 3.
  
  
  RESULTS
  Fifty-seven patients met the inclusion criteria. Fifty patients (88%) were successfully discharged on rapid ambulatory discharge pathway. Six patients (11%) were later readmitted for hematuria (3), urinary retention (1), or cardiac events (2). Two patients (4%) had emergency department visits for catheter-related problems. Increasing length of surgery, increasing amount of laser energy used, and a surgical indication indicative of more advanced disease were associated with postoperative hospitalization and readmissions on univariate analysis. No patient operated on for lower urinary tract symptoms was hospitalized or needed a readmission. The mean change in International Prostate Symptom Score and quality of life at 3 months were -12.5 ± 8.2 (P <.001) and -2.6 ± 1.7 (P <.001), respectively.
  
  
  CONCLUSIONS
  It is safe to use a rapid ambulatory discharge pathway for laser prostatectomy in high anesthetic risk patients with good short-term outcomes, especially in men operated on for lower urinary tract symptoms.
authors.affiliation: Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: johann.p.ingimarsson@hitchcock.org.
authors.forename: Johann P
authors.initials: JP
authors.lastname: Ingimarsson
authors.affiliation: Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Herrick
authors.affiliation: Concord Hospital Center for Urological Care, Concord, NH.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Yap
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D006304:Health Status; D006417:Hematuria / Q000209:etiology / Q000601:surgery; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use; D059411:Lower Urinary Tract Symptoms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery