| Title: |
Trends in immediate perioperative morbidity and delay in discharge after open and minimally invasive radical prostatectomy ( RP): a 20‐year institutional experience |
| Authors: |
Pierorazio, Phillip M.; Mullins, Jeffrey K.; Ross, Ashley E.; Hyams, Elias S.; Partin, Alan W.; Han, Misop; Walsh, Patrick C.; Schaeffer, Edward M.; Pavlovich, Christian P.; Allaf, Mohamad E.; Bivalacqua, Trinity J. |
| Source: |
BJU International ; volume 112, issue 1, page 45-53 ; ISSN 1464-4096 1464-410X |
| Publisher Information: |
Wiley |
| Publication Year: |
2013 |
| Collection: |
Wiley Online Library (Open Access Articles via Crossref) |
| Description: |
What's known on the subject? and What does the study add? Standard clinical care pathways to discharge have been established for a number of operations including radical prostatectomy ( RP ). The pathway after RP has changed dramatically over the past two decades due to improvements in surgical technique, anaesthesia and most recently, the introduction of minimally invasive RP ( MIRP ). This study adds evidence that the emergence of MIRP is associated with a decrease in LOS for all patients undergoing RP . In addition, it catalogues the development of the clinical care pathway over 20 years at a large, tertiary care hospital with extensive experience in RP . Finally, it defines the common reasons patients fall ‘off‐pathway’ (ileus, urine leak, anaemia and re‐exploration for bleeding) and defines the immediate perioperative morbidity profile of RP . Specifically, it addresses approach‐specific morbidities and indicates that MIRP is associated with higher rates of ‘off‐pathway’ discharge, most often due to ileus. Objective To investigate the development of the clinical care pathway to discharge after radical prostatectomy ( RP ) at a large, academic medical centre over the past 20 years, focusing on the rates and reasons for deviation. Patients and Methods In all, 18 049 men were identified from the Johns Hopkins RP database who had undergone surgery since 1991. Patients in whom the length of stay ( LOS ) was ≤95th percentile, defined the clinical care pathway to discharge and those in whom LOS was ≥98th percentile were termed ‘off‐pathway’. Results The mean LOS decreased from 7.7 days in 1991 to 1.6 days in 2010. Of 7126 patients undergoing RP since 2005, 1803(25.3%), 4881(68.5%) and 312 (4.4%) were discharged on postoperative day ( POD ) 1, 2 and 3, respectively; 126 (1.8%) patients, discharged on POD4–21 were ‘off‐pathway’. The most common reasons for delay of discharge were ileus (44, 0.615%), urine leak (12, 0.17%), anaemia requiring blood transfusion (nine, 0.126%) and bleeding requiring re‐exploration (six, ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1111/j.1464-410x.2012.11767.x |
| DOI: |
10.1111/j.1464-410X.2012.11767.x/fullpdf |
| Availability: |
https://doi.org/10.1111/j.1464-410x.2012.11767.x; https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fj.1464-410X.2012.11767.x; http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1464-410X.2012.11767.x/fullpdf |
| Rights: |
http://onlinelibrary.wiley.com/termsAndConditions#vor |
| Accession Number: |
edsbas.1878A4EC |
| Database: |
BASE |