OVERNIGHT HOSPITALIZATION AFTER RADICAL PROSTATECTOMY - THE IMPACT OF2 CLINICAL PATHWAYS ON PATIENT SATISFACTION, LENGTH OF HOSPITALIZATION, AND MORBIDITY

Changes in health care have prompted efforts to reduce length of hospi talization while maintaining quality care. Therefore, we evaluated sho rt-term outcomes after radical retropubic prostatectomy on 100 consecu tive men undergoing surgery for clinically localized prostate cancer p erformed under epidural anesthesia followed by epidural morphine or co mbined with spinal anesthesia using bupivacaine and fentanyl (25 mu g) and followed by IM methadone (10-20 mg). All patients received oral a cetaminophen and ibuprofen beginning 4 h after surgery. Length of hosp ital stay, responses to written satisfaction survey, postoperative mor bidity and readmission to the hospital were recorded. Using either pat hway, 83% of the patients were discharged after one night in the hospi tal. The mean hospital stay was 1.34 +/- 1.10 and 1.28 +/- 1.0 days, r espectively. Although three men were rehospitalized, it was not becaus e of the early discharge. More than 95% of patients were satisfied wit h pain control, and patients discharged after one night were not more likely to be dissatisfied than patients hospitalized longer. Implicati ons: Both clinical pathways provide excellent anesthesia and analgesia and allow discharge 1 day after radical retropubic prostatectomy. Sho rtened hospital stay does not increase patient dissatisfaction or add to postoperative morbidity. Patients undergoing other pelvic and abdom inal operations may also derive similar benefits using these pathways.