Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy

Kaye, Deborah R.; Syrjamaki, John; Ellimoottil, Chad; Schervish, Edward; Solomon, Marius M.; Linsell, Susan; Montie, James E.; Miller, David C.; Dupree, James M.; Collaborative, Michigan Urological Surgery Improvement

doi:10.1016/j.urology.2017.11.004

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…Type of surgery showed significant main effects, with the highest scores reported for the RP group, followed by the R/PN group and the worst scores for the RC group, which concurs with other studies on short-term recovery and QoL after such surgeries [25,26]. We further analyzed the type of surgery by time of survey interaction.…”

Section: Discussionsupporting

confidence: 88%

Validation of a German translation of the CARE questionnaire and its implementation as electronic PROM to assess patient-reported postoperative convalescence and recovery after major urological surgery

et al. 2021

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Purpose To validate a German translation of the convalescence and recovery evaluation (CARE) as an electronic patient-reported outcome measure (ePROM) and use it to assess recovery after major urological surgery. Methods The CARE questionnaire was provided to patients scheduled for major urological surgery preoperatively, at discharge and 6 weeks postoperatively, using an ePROM system. Cronbach’s alpha, inter-scale correlations and confirmatory factor analysis (CFA) were used to validate the translation. Mixed linear regression models were used to identify factors influencing CARE results, and a multivariable logistic regression analysis was done to determine the predictive value of CARE results on quality of life (QoL). Results A total of 283 patients undergoing prostatectomy (n = 146, 51%), partial/radical nephrectomy (n = 70, 25%) or cystectomy (n = 67, 24%) responded to the survey. Internal consistency was high (α = 0.649–0.920) and the CFA showed a factor loading > 0.5 in 17/27 items. Significant main effects were found for the time of survey and type of surgery, while a time by type interaction was only found for the gastrointestinal subscale ($$\chi_{(4)}^{2}$$ χ ( 4 ) 2 = 30.37, p < 0.0001) and the total CARE score (TCS) ($$\chi_{(4)}^{2}$$ χ ( 4 ) 2 = 13.47, p = 0.009) for cystectomy patients, meaning a greater score decrease at discharge and lower level of recovery at follow-up. Complications demonstrated a significant negative effect on the TCS ($$\chi_{(2)}^{2}$$ χ ( 2 ) 2 = 8.61, p = 0.014). A high TCS at discharge was an independent predictor of a high QLQ-C30 QoL score at follow-up (OR = 5.26, 95%-CI 1.42–19.37, p = 0.013). Conclusion This German translation of the CARE can serve as a valid ePROM to measure recovery and predict QoL after major urological surgery.

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Section: Discussionsupporting

confidence: 88%

Validation of a German translation of the CARE questionnaire and its implementation as electronic PROM to assess patient-reported postoperative convalescence and recovery after major urological surgery

et al. 2021

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“…21 Likewise, home health care services increased ER visit at 16-days (p<0.01), but appeared to be effective for lowering re-admission (p=0.06) ( Table 3). 37 In a short-stay ambulatory extended recovery program aimed at reducing length of stay, drain management lessons, web-based interactive classes, and printed materials did not change re-admission and ER visit after RP (Table 3). 51 However, other support systems with ready-access to healthcare personnel are shown to be more effective.…”

Section: Predictors Of Upv After Rp (56% Reporting)mentioning

confidence: 97%

“…Ten of 60 studies tested interventions, [21][22][23]29,32,37,42,45,51,76 such as standardized care pathways, ERAS and fast-track surgery (FTS), and medical/surgical alterations of clinical course (Table 3). Care pathway-like standardized nursing plans and patient education programs did demonstrate only a slight reduction in re-admission and ER visit ( Table 3).…”

Section: Predictors Of Upv After Rp (56% Reporting)mentioning

confidence: 99%

“…84 Further tailoring and extension of ERAS/FTS programs, using the synthesis herein, can potentially help for longer-term outcomes, such as UPV. Given that the presence of multiple complications and a short length of stay are associated with postoperative re-admissions, 82 and that home health care increases ER visit rate, 37 there is legible value in interventions that focus on specific groups of re-admission reasons, such as catheter problems, DVT and bleeding such as those by Afzal et al and Kubota et al 22,42 Given that LND during RP can increase the rates of DVT/PE events, 77 particular attention is warranted in this subset of RP patients. Older and more comorbid patients have higher risk of major complications after RP; our study finds that GU complications make up the majority of re-admissions, and thus preoperative assessment strategies are crucial.…”

Section: Cuaj -Original Researchmentioning

confidence: 99%

“…Mean of differences=3.39% (95% CI 0.01-6.69%), p=0.0455, pairing effectiveness, p<0.0001. 21,29,30,36,37,44,49,51,53,55,64,66,73,77,78 Bleeding-related (hematoma, hematuria, hemorrhage, unspecified GI/GU bleeding) 21,29,30,43,49,51,53,55,66,73,78 21,29,37,44,47,[49][50][51][52][53][54]64,66,73,78 Nurse-led RARP Care Pathway, "Robocare" with 10steps in Australia -The 10-step pathway is shown in Fig. 1 -A…”

Section: Cuaj -Original Researchmentioning

confidence: 99%

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A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

Mukkala¹,

Song²,

Lee³

et al. 2021

CUAJ

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Introduction: Unplanned visits (UPV) — re-admissions and emergency room (ER) visits — are markers of healthcare system quality. Radical prostatectomy (RP) is a commonly performed cancer procedure, where variation in UPV represents a gap in care for prostate cancer patients. Here, we systematically synthesize the rates, reasons, predictors, and interventions for UPV after RP, to inform evidence-based quality improvement (QI) initiatives. Methods: A systematic review was performed for studies from 2000–2020 using keywords: “re-admission,” “emergency room/department,” “unplanned visit,” and “prostatectomy.” Studies that focused on UPV following RP and that reported rates, reasons, predictors, or interventions, were included. Data was extracted via a standardized form. Meta-analysis was completed. Results: Sixty studies, with 406 107 RP patients, were eligible; 16 028 UPV events (~5%) were analyzed from 317 050 RP patients. UPV rates after RP varied between studies (ER visit range 6–24%; re-admissions range 0–56%). The 30-day and 90-day ER visit rates were 12% and 14%, respectively; the 30-day and 90-day re-admission rates were 4% and 9%, respectively. A total of 55% of all re-admissions after RP are directly due to postoperative genitourinary (GU)-related complications such as strictures, obstructions, fistula, bladder-related, incontinence, urine leak, renal problems, and other unspecified urinary complications. The next most common re-admission reasons were anastomosis-related, infection-related, cardiovascular/pulmonary events, and wound-related issues. Thirty-four percent of all ER visits after RP are directly due to urine-related issues such as retention, urinoma, obstruction, leak, and catheter problems. The next most common ER visit reasons were abdominal/gastrointestinal issues, infection-related, venous thromboembolic events, and wound-related issues. Predictors for increased re-admission included: open RP, lymph node dissection, Charlson comorbidity index≥2, low surgeon/hospital case volume, and socioeconomic determinants of health. Of the 10 interventions evaluated, a 3.4% average reduction in UPV rate was observed, highlighting an approximate two-fold decrease. Meta-analysis demonstrated a significant benefit of interventions over controls with odds ratio 0.62 (95% confidence interval 0.46–0.84). Interventions that used multidisciplinary, nurse-centered, programs, with patient self-care/empowerment were more beneficial than algorithmic patient care pathways and preoperative patient education. Conclusions: Twenty years of international, retrospective, experience suggests UPV after RP are often related to GU complications, infection- or wound-related factors. QI interventions to reduce UPV should target these factors. While many re-admissions after RP appear to be unavoidable, ER visits have more opportunity for volume reduction by QI. The interventions evaluated herein have potential to reduce UPV after RP.

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Association of frailty with long-term homecare utilization in older adults following cancer surgery: Retrospective population-based cohort study

Chesney

Coburn

Mahar

et al. 2021

European Journal of Surgical Oncology

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Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy

Cited by 5 publications

References 8 publications

Validation of a German translation of the CARE questionnaire and its implementation as electronic PROM to assess patient-reported postoperative convalescence and recovery after major urological surgery

Validation of a German translation of the CARE questionnaire and its implementation as electronic PROM to assess patient-reported postoperative convalescence and recovery after major urological surgery

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

Association of frailty with long-term homecare utilization in older adults following cancer surgery: Retrospective population-based cohort study

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