title: Enhanced recovery pathway for radical prostatectomy: Implementation and evaluation in a universal healthcare system.
abstract: BACKGROUND
  Enhanced recovery pathways are standardized, multidisciplinary, consensus-based tools that provide guidelines for evidence-based decision-making. This study evaluates the impact of the implementation of a clinical care pathway on patient outcomes following radical prostatectomy in a universal healthcare system.
  
  
  METHODS
  Medical charts of 200 patients with prostate cancer who underwent open and minimally invasive radical prostatectomy at a single academic hospital from 2009 to 2012 were reviewed. A group of 100 consecutive patients' pre-pathway implementation was compared with 99 consecutive patients' post-pathway implementation. Duration of hospital stay, complications, post-discharge emergency department visits and readmissions were compared between the 2 groups.
  
  
  RESULTS
  Length of hospital stay decreased from a median of 3 (inter-quartile range [IQR] 4 to 3 days) days in the pre-pathway group to a median of 2 (IQR 3 to 2 days) days in the post-pathway group regardless of surgical approach (p < 0.0001). Complication rates, emergency department visits and hospital readmissions were not significantly different in the pre- and post-pathway groups (17% vs. 21%, p = 0.80; 12% vs. 12%, p = 0.95; and 3% vs. 7%, p = 0.18, respectively). These findings were consistent after stratification by surgical approach. Limitations of our study include lack of assessment of patient satisfaction, and the retrospective study design.
  
  
  CONCLUSIONS
  The implementation of a standardized, multidisciplinary clinical care pathway for patients undergoing radical prostatectomy improved efficiency without increasing complication rates or hospital readmissions.
authors.affiliation: Faculty of Medicine, McGill University, Montreal, QC;
authors.forename: Hiba
authors.initials: H
authors.lastname: Abou-Haidar
authors.affiliation: Department of Surgery (Urology), McGill University Health Centre, Montreal, QC;
authors.forename: Samuel
authors.initials: S
authors.lastname: Abourbih
authors.affiliation: Faculty of Medicine, McGill University, Montreal, QC;
authors.forename: David
authors.initials: D
authors.lastname: Braganza
authors.affiliation: Department of Surgery (Urology), McGill University Health Centre, Montreal, QC;
authors.forename: Talal Al
authors.initials: TA
authors.lastname: Qaoud
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, QC;
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Anesthesia, McGill University Health Centre, Montreal, QC;
authors.forename: Franco
authors.initials: F
authors.lastname: Carli
authors.affiliation: Department of Nursing, McGill University Health Centre, Montreal, QC.
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson
authors.affiliation: Department of Surgery (Urology), McGill University Health Centre, Montreal, QC;
authors.forename: Armen G
authors.initials: AG
authors.lastname: Aprikian
authors.affiliation: Department of Surgery (Urology), McGill University Health Centre, Montreal, QC;
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, QC;
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
authors.affiliation: Department of Surgery (Urology), McGill University Health Centre, Montreal, QC;
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf