Surgical and postoperative factors affecting length of hospital stay after radical prostatectomy

Abstract

BACKGROUND Radical prostatectomy continues to comprise the mainstay of therapy for localized prostate carcinoma. However, caring for radical prostatectomy patients accounts for approximately half of the $1.7 billion annual cost of prostate carcinoma treatment. Length of stay (LOS) after surgery appears to be one of the main components of this cost. The first step in reducing cost is to identify those variables associated with LOS. Radical prostatectomy can be performed using two very different surgical techniques and with each technique different costs are incurred. The objective of the current study was to identify factors associated with LOS as a function of surgical approach. To reduce potential biases due to patient requests for longer hospitalization or physician preferences in that regard, secondary objectives were to identify factors associated with time to fluid intake (TTF) and time to consume solid foods (TTS). METHODS An institutional‐based, retrospective chart review of 313 men with clinically localized prostate carcinoma who underwent either a perineal (RPP) or retropubic (RRP) prostatectomy at a single university center from March 1988 to October 1996 was undertaken. Information regarding LOS was available for 311 patients. Linear regression models were used to assess the association between covariables and LOS. Poisson regression models for count data were used to assess associations between covariables and the secondary endpoints of TTF and TTS. Covariables included: preoperative (age, race, prostate specific antigen, Gleason score, clinical stage, lymph node resection, comorbidity, and admission time), intraoperative (surgical approach, surgeon, operative time, estimated blood loss, transfusion requirement, anesthetic approach, and American Society of Anesthesiologists score), and postoperative (pain management complications and transfusions) parameters. RESULTS The median LOS was 4 days (range, 1–19 days) for RPP and 5 days (range, 3–16 days) for RRP approaches. The final model included six main effects and three interaction terms. Overall, LOS decreased over time with LOS decreasing at a faster rate in patients who underwent RPP. In general, patients who underwent RRP had an increased LOS compared with patients who underwent RPP. Complications from surgery and age increased the LOS for all patients; however, the increase was greater in patients who underwent RPP. In addition, the use of intraoperative epidural anesthesia and the increased use of postoperative narcotics were associated with increased LOS for patients undergoing both surgical approaches. TTF and TTS were significantly longer for patients who underwent the retropubic approach compared with those patients who underwent the perineal approach. After adjustment for surgical approach no other covariables were found to be associated with TTF. After adjustment for surgical approach, the occurrence of complications was found to be associated with TTS, indicating that patients who experienced complications took longer before they ...

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

“…Medical expenditures for prostate cancer treatment in the U.S. totaled $1.3 billion in 2000, nearly 30% more than in 1994[38]. Furthermore, RP accounts for approximately half of all prostate cancer expenditures[39]. Given the large number of men with prostate cancer, the effects of treatment have major public health implications, including patient counseling and financial costs.…”

Differences among patients undergoing perineal or retropubic radical prostatectomy in pain and perioperative variables: a prospective study

“…Gardner et al. [21] retrospectively assessed 114 and 197 patients who had PRP and RRP, respectively, and found that the mean time of food intake of the former was 24 h, vs 72 h for the latter group. In another study [11], the authors assessed the time to regular oral feeding, where the mean period was 2.3 days after PRP vs 5.1 days after RRP.…”

Safely reducing length of stay after open radical retropubic prostatectomy under the guidance of a clinical care pathway

“…Our overall perioperative complication rate was quite low (0.66% for major complications and 6.6% for minor complications), and is comparable to that published by other high-volume centers. [12][13][14] Paralytic ileus was responsible for 45% of the complication-related increases in LOS. In an attempt to address this occurrence, we limited the amount of intravenous narcotics used by each patient by discontinuing the routine postoperative use of PCA machines and making intravenous pain medications available on an as-needed basis.…”