Nason Gregory J, Kim Justin K, HeeTan Guan, Ajib Khaled, Nam Robert K
Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON, Canada.
Can Urol Assoc J. 2021 Mar;15(3):E130-E134. doi: 10.5489/cuaj.6600.
The aim of this study was to assess the effect of an enhanced care pathway on length of stay (LOS) for open radical prostatectomy (RP) given that robotic-assisted laparoscopic prostatectomy (RALP) is not available to all patients in Canada.
A retrospective review was conducted of all RPs performed. An enhanced care pathway was established for RPs in 2011. Patients were compared in the period before (2005-2010) and after (2011-2019) the introduction of the pathway.
During the study period, 581 RPs were performed by a single surgeon with a median followup of 66.9 months (range 3-176). A total of 211 (36.3%) RPs were performed from 2005-2010, while 370 (63.9%) were performed from 2011-2019. The median age at RP was 65 years (range 44-81). Following the introduction of an enhanced care pathway, there were significant decreases in intraoperative blood loss (350 ml vs. 200 ml; p=0.0001) and the use of surgical drains (90% vs. 9.5%; p=0.0001). The median LOS over the whole study period was one day (range 1-7), which significantly decreased with the enhanced care pathway (3 vs. 1 day; p=0.0001). Since introducing the enhanced care pathway in 2011, 344 (93%) patients were discharged day 1 following surgery. There were no differences in post-discharge presentations to the emergency department (5.7% vs. 9%; p=0.15) or 30-day readmission rates (3.8% vs. 3.8%; p=1.00).
A single-night stay for open RP is safe and achievable for most patients. A dedicated, multifaceted pathway is required to attain targets for a safe and timely discharge.
鉴于加拿大并非所有患者都能接受机器人辅助腹腔镜前列腺切除术（RALP），本研究旨在评估强化护理路径对开放性根治性前列腺切除术（RP）住院时间（LOS）的影响。
对所有实施的RP手术进行回顾性研究。2011年为RP手术建立了强化护理路径。对路径引入前（2005 - 2010年）和引入后（2011 - 2019年）的患者进行比较。
在研究期间，由一名外科医生实施了581例RP手术，中位随访时间为66.9个月（范围3 - 176个月）。2005 - 2010年共实施了211例（36.3%）RP手术，而2011 - 2019年实施了370例（63.9%）。RP手术时的中位年龄为65岁（范围44 - 81岁）。引入强化护理路径后，术中失血量显著减少（350毫升对200毫升；p = 0.0001），手术引流管的使用也显著减少（90%对9.5%；p = 0.0001）。整个研究期间的中位住院时间为1天（范围1 - 7天），强化护理路径使其显著缩短（3天对1天；p = 0.0001）。自2011年引入强化护理路径以来，344例（93%）患者术后第1天出院。出院后到急诊科就诊情况（5.7%对9%；p = 0.15）或30天再入院率（3.8%对3.8%；p = 1.00）无差异。
对于大多数患者而言，开放性RP术后单晚住院是安全可行的。需要一条专门的、多方面的路径来实现安全及时出院的目标。
