Open Access

ARTICLE

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

R. Ashley McLellan¹, David G. Bell^1,2, Ricardo A. Rendon^1,2

1 Department of Urology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
2 Nova Scotia Cancer Centre, Dalhousie University, Halifax, Nova Scotia, Canada
Address correspondence to Dr. R. A. Rendon, Room 210, 5 South, Victoria Bldg., 1278 Tower Road, Halifax, Nova Scotia B3H 2Y9 Canada

Canadian Journal of Urology 2006, 13(5), 3244-3249.

Abstract

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.

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