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Effective analgesia and decreased length of stay for patients undergoing radical prostatectomy: effectiveness of a clinical pathway

McLellan Ashley R.; Bell G. David; Rendon A. Ricardo; Department of Urology, Queen Elizabeth II Health Sciences Centre, Dalhousie Univ

Oct 2006 (Vol. 13, Issue 5, Pages( 3244 - 3249)

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OBJECTIVES: To assess the impact of a clinical pathway (CP) on length of stay (LOS), complications, readmission rates, and patient satisfaction for patients undergoing a radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: A standardized CP for all patients undergoing RRP was developed and implemented. Post-operatively, patients enrolled in the CP received oral ibuprofen and acetaminophen analgesia, with oral and subcutaneous narcotics available for breakthrough pain. Patients enrolled in the CP were compared to a pre-CP historical cohort. Patients were asked to complete a short, validated satisfaction questionnaire 10 days post-operatively. RESULTS: Sixty-eight consecutive patients underwent a RRP following CP implementation and were compared to a historical cohort of 147 pre-CP patients. Median LOS decreased by 50% (4 days versus 2 days, p < 0.0001) while complication and readmission rates were unchanged. Patient satisfaction was high in all domains. Overall, 29.4% of patients treated within the CP required no narcotic analgesia during their admission. CONCLUSIONS: The implementation of a CP for patients undergoing a RRP is a simple and effective method for reducing LOS without compromising complication, readmission rates or patient satisfaction.