Early hospital discharge after radical retropubic prostatectomy: impact on cost and complication rate.

OBJECTIVES

To assess the impact of shortened hospital stay after radical retropubic prostatectomy for localized prostate cancer on complication rates and hospital costs.

METHODS

A comparison of results between 171 consecutive patients undergoing radical retropubic prostatectomy between July 1989 and January 1993 (group 1) and 101 consecutive patients operated on since February 1993 (group 2) during a prospective effort to reduce hospital length of stay by home-based preoperative bowel preparation, direct admission to the operating room on the day of surgery, earlier and more extensive postoperative ambulation, earlier initiation of postoperative oral intake, earlier use of oral analgesics, and routine pelvic drain removal at 72 to 96 hours after surgery independent of volume of drainage.

RESULTS

Median length of stay was reduced from 8 to 5 days (p < 0.0001, group 1 versus group 2), with 10% of patients in group 2 having hospital stays of 4 days or less. The overall nature and rate of complications (13.5% versus 11.9%, p = NS) were similar in both groups. Reduced length of stay was associated with a 32% decrease in hospital-associated cost per case in group 2 versus group 1 for patients in diagnosis-related group (DRG) 334 (radical prostatectomy with comorbidity) and a 26% decrease for DRG 335 (radical prostatectomy without comorbidity).

CONCLUSIONS

Reduced hospital length of stay after radical retropubic prostatectomy results in significant cost savings without increasing morbidity.