CHICAGO--A new critical pathway for radical prostatectomy introduced
at Chicago's Weiss Memorial Hospital has lowered hospital stays
for these patients to a mean of 1.7 days, compared with 4.6 days
for patients treated under the previous protocol. The shorter
stays did not affect surgical outcome or reduce patient satisfaction,
report Gerald W. Chodak, MD and his colleagues at the University
of Chicago Medical Center.
More than one third of the 27 patients in the study group (37%)
were discharged after one night, while none of the 20 controls
who underwent conventional management were discharged that early.
None of the study patients required re-hospitalization. Overall,
the findings suggest that same-day discharge is now a possibility
for some radical prostatectomy patients, the investigators say.
In addition to shorter hospital stays, the new protocol also led
to significant reductions in average time in the operating room
(3.7 hours vs 4.9 hours for controls) and in estimated blood loss.
In the new protocol, blood lost during the operation is salvaged
and processing using a cell saver, and reinfused only if the estimated
blood loss is more than one liter. Eleven of the study patients
had no need for transfusions.
Patient charges for the study patients were reduced by 32% (from
an average of $20,000 to less than $14,000), and hospital costs
were reduced by 35% (Urology 47:23-28, 1996).
The new approach involved extensive preoperative patient education,
a shift from general to epidural anesthesia, minor changes in
the surgical procedure, an accelerated recovery period that eliminated
postoperative narcotics, and a quick return to moderate activity
and a normal diet.
The crucial factors were the use of epidural pain relief, which
results in less blood loss and quicker recovery, and preoperative
education, a process that "makes the patient part of the
treatment team," Dr. Chodak says.