EARLY HOSPITAL DISCHARGE AFTER RADICAL RETROPUBIC PROSTATECTOMY - IMPACT ON COST AND COMPLICATION RATE

Objectives. To assess the impact of shortened hospital stay after radi cal retropubic prostatectomy for localized prostate cancer on complica tion rates and hospital costs. Methods. A comparison of results betwee n 171 consecutive patients undergoing radical retropubic prostatectomy between July 1989 and January 1993 (group 1) and 101 consecutive pati ents operated on since February 1993 (group 2) during a prospective ef fort to reduce hospital length of stay by home-based preoperative bowe r preparation, direct admission to the operating room on the day of su rgery, earlier and more extensive postoperative ambulation, earlier in itiation of postoperative oral intake, earlier use of oral analgesics, and routine pelvic drain removal at 72 to 96 hours after surgery inde pendent of volume of drainage. Results. Median length of stay was redu ced from 8 to 5 days (p < 0.0001, group 1 versus group 2), with 10% of patients in group 2 having hospital stays of 4 days or less. The over all nature and rate of complications (13.5% versus 11.9%, p = NS) were similar in both groups. Reduced length of stay was associated with a 32% decrease in hospital-associated cost per case in group 2 versus gr oup 1 for patients in diagnosis-related group (DRG) 334 (radical prost atectomy with comorbidity) and a 26% decrease for DRG 335 (radical pro statectomy without comorbidity). Conclusions. Reduced hospital length of stay after radical retropubic prostatectomy results in significant cost savings without increasing morbidity.