MAINTAINING QUALITY OF CARE AND PATIENT SATISFACTION WITH RADICAL PROSTATECTOMY IN THE ERA OF COST-CONTAINMENT

Objectives. To determine the effect of shortened hospital stay after r adical retropubic prostatectomy on costs, adverse surgical outcomes, a nd patient satisfaction. Methods. The effect of changes in preoperativ e counseling, perioperative care, and analgesic management on hospital length of stay; mean cost per case and cost per hospital day; and 30- day complication, hospital readmission, and mortality rates were analy zed for a consecutive sample of 374 patients undergoing radical prosta tectomy between July 1989 and November 1995. satisfaction with length of stay, analgesic regimen, and surgical outcome was assessed in a ran dom subset of 150 patients by anonymous questionnaire. Results. Length of stay (LOS) was shortened from a median 7 to 2 nights after surgery during the study (P < 0.0001), whereas the acute complication, 30-day readmission, and 30-day mortality rates remained constant. Reducing L OS resulted in a 43% decrease in mean cost per case while mean cost pe r day increased by 22% to 35%. Overall patient satisfaction was high, with 83.5% of patients rating LOS as ''just right'' and 89.2% reportin g they were ''satisfied'' or ''very satisfied'' with their pain contro l after surgery. Conclusions. Shortened LOS after radical retropubic p rostatectomy can be accomplished safely and can meet with high levels of patient satisfaction while significantly reducing hospital-related costs. The potential for further incremental reductions in cost with r eductions in LOS to less than 2 nights appears to be small, and future efforts at cost reduction for this procedure should center on decreas ing the intensity of care during hospitalization.