Enhanced recovery pathway for radical prostatectomy: Implementation and evaluation in a universal healthcare system

Abstract

Introduction: Enhanced recovery pathways are standardized, multidisciplinary, consensus-based tools that provide guidelines for evidence-based decision-making. This study evaluates the impact of the implementation of a clinical care pathway on patient outcomes following radical prostatectomy in a universal healthcare system.Methods: Medical charts of 200 patients with prostate cancer who underwent open and minimally invasive radical prostatectomy at a single academic hospital from 2009 to 2012 were reviewed. A group of 100 consecutive patients’ pre-pathway implementation was compared with 99 consecutive patients’ post-pathway implementation. Duration of hospital stay, complications, post-discharge emergency department visits and readmissions were compared between the 2 groups.Results: Length of hospital stay decreased from a median of 3 (interquartile range [IQR] 4 to 3 days) days in the pre-pathway group to a median of 2 (IQR 3 to 2 days) days in the post-pathway group regardless of surgical approach (p < 0.0001). Complication rates, emergency department visits and hospital readmissions were not significantly different in the pre- and post-pathway groups (17% vs. 21%, p = 0.80; 12% vs. 12%, p = 0.95; and 3% vs. 7%, p = 0.18, respectively). These findings were consistent after stratification by surgical approach. Limitations of our study include lack of assessment of patient satisfaction, and the retrospective study design.Conclusions: The implementation of a standardized, multidisciplinary clinical care pathway for patients undergoing radical prostatectomy improved efficiency without increasing complication rates or hospital readmissions.

Atividades de enfermagem ao paciente prostatectomizado

“…Entretanto, a hiponatremia é uma complicação que pode ocorrer no pós-operatório de prostatectomia e, portanto, a equipe de enfermagem deve estar apta a conhecer a fisiopatologia e os sinais e sintomas dessa alteração, a fim de reduzir as complicações e melhorar a recuperação do paciente. Em estudo sobre a criação e implementação de um Enhanced recovery after surgery pathways, ferramenta implementada internacionalmente, com vistas a fornecer diretrizes para a tomada de decisão baseada em evidências, tendo como meta maior homogeneizar a assistência, sem comprometer a qualidade do atendimento em pacientes prostatectomizados radicalmente, identificou-se a associação entre essa ferramenta e a diminuição do tempo de internação hospitalar e das taxas de complicação pós-operatória e readmissões 23 . Nesse sentido, os profissionais responsáveis por identificar, prevenir e tratar as complicações relacionadas ao pós-operatório da prostatectomia deverão buscar ferramentas que subsidiem sua prática.…”

Enhanced recovery after urologic surgery—Current applications and future directions

“…Enhanced recovery protocols have been applied to radical prostatectomy with decreased length of stay, decreased blood loss, and decreased costs primarily through standardization of perioperative care among these patients . Other centers have implemented ERAS pathways for patients undergoing radical prostatectomy with resultant shortened length of stay and quicker return of bowel function among these patients . Most significant avenues for quality improvement in procedures such as robotic‐assisted radical prostatectomy, retroperitoneal lymph node dissection, and renal surgeries will derive from the standardization of outcomes and potential improvements to patient experience and quality of life prior to and following these procedures.…”

“…66,67 Other centers have implemented ERAS pathways for patients undergoing radical prostatectomy with resultant shortened length of stay and quicker return of bowel function among these patients. [68][69][70] Most significant avenues for quality improvement in procedures such as robotic-assisted radical prostatectomy, retroperitoneal lymph node dissection, and renal surgeries will derive from the standardization of outcomes and potential improvements to patient experience and quality of life prior to and following these procedures. ORCID Daniel Zainfeld http://orcid.org/0000-0003-2876-9586…”

Introduction to Enhanced Recovery Programs: A Paradigm Shift in Perioperative Care

“…In our institution, all patients start the pathway in the preoperative clinic where standard educational information is reviewed by the preoperative nurses. Outcomes have been consistent in terms of reductions in hospital stay for prostatectomy [28], esophagectomy [29], colorectal surgery [25,30] and lung resection [31], earlier time to achieve recovery milestones [25,31], reduced infections [31], and lower costs [25,32].…”