Assessing Morbidity Following Radical Prostatectomy. A Tertiary, Non-Teaching Urology Center’s ExperiencePublished on June 1, 2011
Co-authored by Dr. Kevin Carlson, Dr. Ryan Flannigan and Dr. Bryan Donnelly, was presented at the Annual Meeting of the Canadian Urological Association (CUA) in Montreal, QB on June 21, 2011. This study evaluated complications of men undergoing radical prostatectomy for prostate cancer and the impact of a standardized post-operative care program.
Background: Insight into morbidity following radical prostatectomy may lend to improved future patient care. The objective of the current study was to determine the morbidity following radical prostatectomy in a tertiary, non-teaching urological centre.
Methods: Patients who underwent a radical prostatectomy (RP) in 2008 were retrospectively evaluated in this study. Post-operative morbidity for the entire cohort was assessed using the Modified Clavien Scale (MCS). Those patients readmitted to hospital or who visited an urban or rural emergency department (ED) within 90 days of surgery were further evaluated to determine reason for readmission.
Results: At our centre, 321 patients underwent RP in 2008 by 11 surgeons. 274 cases (85.4%) were done with an open retropubic technique, and 47 cases (14.6%) by laparoscopic technique (non-robotic). Seventy-seven patients overall (24.0%) visited an ED within 90 days, and 14 of these were readmitted to hospital, with an additional patient readmitted directly (total 15 readmissions, 4.7% overall). No patients died within the 90-day postoperative period. Results and readmission reasons are detailed in table 1 and 2. In 2009 we launched a pilot study wherein 115 RP patients received scheduled and on-demand follow-up care between May and November. 90-day readmission rates amongst this cohort dropped to 5% and 2.6% for ED visits and hospital readmission respectively.
Conclusions: This study uniquely reflects practice in a tertiary non-teaching centre. A significant number of patients presented back to hospital within 90 days following radical prostatectomy. Most of these patients (80.8%) were managed entirely through an outpatient ED, and many of these visits were for routine postoperative care. Only 18.2% (4.7% of the 321 prostatectomy patients) were readmitted to hospital. These data point to a need for enhanced postoperative support of patients to reduce costly and often unnecessary visits to acute care emergency departments. This conclusion is supported by our early experience.