Using outcome data and patient satisfaction surveys to develop policies regarding minimum length of hospitalization after radical prostatectomy

Objectives. Changes in health care economics have prompted new clinical pat hways for radical prostatectomy to reduce length of hospitalization after s urgery to 1 day. We evaluated satisfaction, outcomes, and short-term morbid ity in 187 consecutive patients with overnight hospitalization after radica l retropubic prostatectomy (RRP). Methods. In 1995, we initiated a critical pathway for RRP that included epi dural anesthesia with or without spinal anesthesia and postoperative methad one, acetaminophen, and ibuprofen for pain control. Patients were discharge d when they were afebrile, tolerating a regular diet, ambulating without as sistance, and using oral medications for analgesia. An 18-item satisfaction survey was mailed to each patient 3 weeks after discharge. Responses to th e postoperative survey, morbidity, blood loss, and use of transfusions were recorded. Results. Of 252 patients who underwent RRP, 187 (74.2%) were discharged 1 d ay after surgery. The mean age of patients was 61.4 years (range 42 to 73). A pelvic lymphadenectomy was performed in addition to the RRP in 32 men (1 7%). Epidural anesthesia with or without spinal anesthesia was used for all but 3 patients. The mean estimated blood loss was 1166 mL, and 24 patients (12.8%) required transfusion, with a mean of 1.9 U (range 1 to 6) of packe d red blood cells. The postoperative complication rate was 11.8%, of which 2.1% (n = 4) were definitely or probably related to our protocol. These com plications included clot retention (n = 2), gastrointestinal bleeding (n = 1), and spinal headache (n = 1). Three of 187 patients were readmitted to t he hospital within 30 days but only one (0.5%) required admission because o f our protocol. The survey response rate was 91.4%. No patient was dissatis fied with his overall care, and only 10.5% of patients would have preferred to stay in the hospital longer. Conclusions, One-day hospitalization after RRP is associated with minimal p ostoperative morbidity and high patient satisfaction. Similar data are need ed for RRP from other centers before policy decisions regarding the length of stay after this procedure are made.UROLOGY 56: 101-107, 2000. (C) 2000, Elsevier Science Inc.