Radical Retropubic Prostatectomy on Outpatient Basis

• Bruno Costa do Prado

  Division of Urology, University of São Paulo Medical School, and Instituto do Cancer do Estado de São Paulo, Avenida Dr. Arnaldo, 251-CEP 01246-000-São Paulo, SP, Brazil

• Claudia Marquez Simões

  Division of Urology, University of São Paulo Medical School, and Instituto do Cancer do Estado de São Paulo, Avenida Dr. Arnaldo, 251-CEP 01246-000-São Paulo, SP, Brazil

• Flávio Guilherme Moreira Arêas

  Division of Urology, University of São Paulo Medical School, and Instituto do Cancer do Estado de São Paulo, Avenida Dr. Arnaldo, 251-CEP 01246-000-São Paulo, SP, Brazil

• Alexandre Crippa

  Division of Urology, University of São Paulo Medical School, and Instituto do Cancer do Estado de São Paulo, Avenida Dr. Arnaldo, 251-CEP 01246-000-São Paulo, SP, Brazil

• Marcos Francisco Dall’Oglio

  Division of Urology, University of São Paulo Medical School, and Instituto do Cancer do Estado de São Paulo, Avenida Dr. Arnaldo, 251-CEP 01246-000-São Paulo, SP, Brazil

 Introduction: This study evaluated the possibility of performing in our midst the open radical prostatectomy with discharge on the same day of the procedure, aiming the improvement of postoperative recovery and reduce hospital costs without loss of quality of care, or decreased patient satisfaction with treatment.

Patients and Methods: We selected 27 patients with localized prostate cancer during the period from April 2011 to January 2012, which had a low surgical risk and opted for the open radical prostatectomy. We evaluated the feasibility of outpatient open radical prostatectomy, perioperative complications, and patient satisfaction with treatment.

Results: Eleven (40.7%) patients were discharged on the same day of the procedure; thirteen were discharged in the morning after surgery and three in the second postoperative day. All patients underwent general anesthesia. The use of opioids in safe doses for epidural anesthesia was administered in 13 patients, improving pain control and enabling early discharge in 8 (61.5%) patients. Only 3 (21.4%) patients who did not receive epidural opioid achieved discharge on the same day of surgery (p = 0.04). No patient had a major complication or was readmitted to the hospital. There was no difference in patient satisfaction with treatment between the group of the same day surgery and the patients with longer hospitalization.

Conclusion: The open radical prostatectomy can be performed with safety on an outpatient basis, in properly selected patients, with no decrease in patient satisfaction with treatment.

Brasil. Ministério do Brasil. Instituto Nacional de Câncer. Estimativa 2012: incidência de câncer no Brasil

Brasil. Ministério do Brasil. Departamento de Informação do SUS. Morbidade Hospitalar do SUS - por local de internação – Brasil

Leibman BD, Dillioglugil O, Abbas F, Tanli S, Kattan MW, Scardino PT. Impact of a clinical pathway for radical retropubic prostatectomy. Urology 1998; 52: 94-9. http://dx.doi.org/10.1016/S0090-4295(98)00130-7

Litwin MS, Smith RB, Thind A, Reccius N, Blanco-Yarosh M, deKernion JB. Cost-efficient radical prostatectomy with a clinical care path. J Urol 1996; 155: 989-93. http://dx.doi.org/10.1016/S0022-5347(01)66365-1

Koch MO, Smith JA Jr, Hodge EM, Brandell RA. Prospective development of a cost-efficient program for radical retropubic prostatectomy. Urology 1994; 44: 311-8. http://dx.doi.org/10.1016/S0090-4295(94)80083-9

Klein EA, Grass JA, Calabrese DA, Kay RA, Sargeant W, O'Hara JF. Maintaining quality of care and patient satisfaction with radical prostatectomy in the era of cost containment. Urology 1996; 48: 269-76. http://dx.doi.org/10.1016/S0090-4295(96)00160-4

Chang SS, Cole E, Smith JA Jr, Baumgartner R, Wells N, Cookson MS. Safely reducing length of stay after open radical retropubic prostatectomy under the guidance of a clinical care pathway. Cancer 2005; 104: 747-51. http://dx.doi.org/10.1002/cncr.21233

Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997; 78: 606-17. http://dx.doi.org/10.1093/bja/78.5.606

Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ 2001; 322: 473-76. http://dx.doi.org/10.1136/bmj.322.7284.473

Gralla O, Haas F, Knoll N, et al. Fast-track surgery in laparoscopic radical prostatectomy: basic principles. World J Urol 2007; 25: 185-91. http://dx.doi.org/10.1007/s00345-006-0139-2

Magheli A, Knoll N, Lein M, Hinz S, Kempkensteffen C, Gralla O. Impact of fast-track postoperative care on intestinal function, pain, and length of hospital stay after laparoscopic radical prostatectomy. J Endourol 2011; 25: 1143-7. http://dx.doi.org/10.1089/end.2011.0020

Saito FJ, Dall'Oglio MF, Ebaid GX, Bruschini H, Chade DC, Srougi M. Learning curve for radical retropubic prostatectomy. Int Braz J Urol 2011; 37: 67-74. http://dx.doi.org/10.1590/S1677-55382011000100009

Ficarra V, Novara G, Artibani W, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 2009; 55: 1037-63. http://dx.doi.org/10.1016/j.eururo.2009.01.036

Bolenz C, Gupta A, Hotze T, et al. Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol 2010; 57: 453-8. http://dx.doi.org/10.1016/j.eururo.2009.11.008

Srougi M, Nesrallah LJ, Kauffmann JR, Nesrallah A, Leite KR. Urinary continence and pathological outcome after bladder neck preservation during radical retropubic prostatectomy: a randomized prospective trial. J Urol 2001; 165: 815-8. http://dx.doi.org/10.1016/S0022-5347(05)66534-2

Lepor H, Nieder AM, Ferrandino MN. Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol 2001; 166: 1729-33. http://dx.doi.org/10.1016/S0022-5347(05)65662-5

Fu Q, Moul JW, Sun L. Contemporary radical prostatectomy. Prostate Cancer 2011; 2011: 645030. http://dx.doi.org/10.1155/2011/645030

Lloyd JC, Bañez LL, Aronson WJ, et al. Estimated blood loss as a predictor of PSA recurrence after radical prostatectomy: results from the SEARCH database. BJU Int 2010; 105: 347-51. http://dx.doi.org/10.1111/j.1464-410X.2009.08792.x

Hajjar JH, Budd HA, Wachtel Z, Howhannesian A. Ambulatory radical retropubic prostatectomy. Urology 1998; 51: 443-8. http://dx.doi.org/10.1016/S0090-4295(97)00716-4

Dudderidge TJ, Doyle P, Mayer EK, et al. Evolution of care pathway for laparoscopic radical prostatectomy. J Endourol 2012; 26: 660-5. http://dx.doi.org/10.1089/end.2011.0427

Martin AD, Nunez RN, Andrews JR, Martin GL, Andrews PE, Castle EP. Outpatient prostatectomy: too much too soon or just what the patient ordered. Urology 2010; 75: 421-4. http://dx.doi.org/10.1016/j.urology.2009.08.085

Brasil. Ministério da Saúde. Sistema de Gerenciamento da Tabela de Procedimentos e OPM do SUS.

Tomaszewski JJ, Matchett JC, Davies BJ, Jackman SV, Hrebinko RL, Nelson JB. Comparative hospital cost-analysis of open and robotic-assisted radical prostatectomy. Urology 2012; 80: 126-9. http://dx.doi.org/10.1016/j.urology.2012.03.020

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