Ambulatory Extended Recovery: Safely Transitioning to Overnight Observation for Minimally Invasive Prostatectomy

John E. Musser*, Melissa J. Assel, Joshua J. Meeks, Daniel D. Sjoberg, Andrew J. Vickers, Jonathan A. Coleman, James A. Eastham, Raul O. Parra, Peter T. Scardino, Karim A. Touijer, Vincent P. Laudone

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Introduction: We evaluated the safety and efficacy of a clinical pathway designed and implemented to transition inpatient minimally invasive radical prostatectomy to a procedure with overnight observation. Methods: In April 2011 ambulatory extended recovery was implemented at our institution. This was a multidisciplinary program of preoperative teaching and postoperative care for patients undergoing minimally invasive radical prostatectomy. We compared the risk of requiring a more than 1-night hospital stay by patients treated with surgery the year before the program vs those treated after the program was initiated, adjusting for age, ASA® status and surgery type. We also examined the rates of readmission and urgent care visits within 48 hours, and 7 and 30 days before and after the program began. Results: The proportion of patients who stayed longer than 1 night was 53% in the year before initiating the ambulatory extended recovery program vs 8% during the program, representing an adjusted absolute risk decrease of 45% (95% CI 39-50, p <0.0001). There was no important predictor of a greater than 1-night length of stay among ambulatory extended recovery patients. Rates of readmission and urgent care visits were slightly lower during the ambulatory extended recovery phase with no significant difference between the groups. Conclusions: The ambulatory extended recovery program successfully transitioned most patients to a 1-night hospital stay without resulting in an increased rate of readmission or urgent care visits.

Original languageEnglish (US)
Pages (from-to)121-125
Number of pages5
JournalUrology Practice
Volume2
Issue number3
DOIs
StatePublished - May 1 2015

Fingerprint

Prostatectomy
Observation
Ambulatory Care
Length of Stay
Preoperative Care
Critical Pathways
Postoperative Care
Inpatients
Teaching
Safety

Keywords

  • Critical pathways
  • Laparoscopy
  • Length of stay
  • Prostate
  • Prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Musser, J. E., Assel, M. J., Meeks, J. J., Sjoberg, D. D., Vickers, A. J., Coleman, J. A., ... Laudone, V. P. (2015). Ambulatory Extended Recovery: Safely Transitioning to Overnight Observation for Minimally Invasive Prostatectomy. Urology Practice, 2(3), 121-125. https://doi.org/10.1016/j.urpr.2014.10.001
Musser, John E. ; Assel, Melissa J. ; Meeks, Joshua J. ; Sjoberg, Daniel D. ; Vickers, Andrew J. ; Coleman, Jonathan A. ; Eastham, James A. ; Parra, Raul O. ; Scardino, Peter T. ; Touijer, Karim A. ; Laudone, Vincent P. / Ambulatory Extended Recovery : Safely Transitioning to Overnight Observation for Minimally Invasive Prostatectomy. In: Urology Practice. 2015 ; Vol. 2, No. 3. pp. 121-125.
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Musser, JE, Assel, MJ, Meeks, JJ, Sjoberg, DD, Vickers, AJ, Coleman, JA, Eastham, JA, Parra, RO, Scardino, PT, Touijer, KA & Laudone, VP 2015, 'Ambulatory Extended Recovery: Safely Transitioning to Overnight Observation for Minimally Invasive Prostatectomy', Urology Practice, vol. 2, no. 3, pp. 121-125. https://doi.org/10.1016/j.urpr.2014.10.001

Ambulatory Extended Recovery : Safely Transitioning to Overnight Observation for Minimally Invasive Prostatectomy. / Musser, John E.; Assel, Melissa J.; Meeks, Joshua J.; Sjoberg, Daniel D.; Vickers, Andrew J.; Coleman, Jonathan A.; Eastham, James A.; Parra, Raul O.; Scardino, Peter T.; Touijer, Karim A.; Laudone, Vincent P.

In: Urology Practice, Vol. 2, No. 3, 01.05.2015, p. 121-125.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ambulatory Extended Recovery

T2 - Safely Transitioning to Overnight Observation for Minimally Invasive Prostatectomy

AU - Musser, John E.

AU - Assel, Melissa J.

AU - Meeks, Joshua J.

AU - Sjoberg, Daniel D.

AU - Vickers, Andrew J.

AU - Coleman, Jonathan A.

AU - Eastham, James A.

AU - Parra, Raul O.

AU - Scardino, Peter T.

AU - Touijer, Karim A.

AU - Laudone, Vincent P.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Introduction: We evaluated the safety and efficacy of a clinical pathway designed and implemented to transition inpatient minimally invasive radical prostatectomy to a procedure with overnight observation. Methods: In April 2011 ambulatory extended recovery was implemented at our institution. This was a multidisciplinary program of preoperative teaching and postoperative care for patients undergoing minimally invasive radical prostatectomy. We compared the risk of requiring a more than 1-night hospital stay by patients treated with surgery the year before the program vs those treated after the program was initiated, adjusting for age, ASA® status and surgery type. We also examined the rates of readmission and urgent care visits within 48 hours, and 7 and 30 days before and after the program began. Results: The proportion of patients who stayed longer than 1 night was 53% in the year before initiating the ambulatory extended recovery program vs 8% during the program, representing an adjusted absolute risk decrease of 45% (95% CI 39-50, p <0.0001). There was no important predictor of a greater than 1-night length of stay among ambulatory extended recovery patients. Rates of readmission and urgent care visits were slightly lower during the ambulatory extended recovery phase with no significant difference between the groups. Conclusions: The ambulatory extended recovery program successfully transitioned most patients to a 1-night hospital stay without resulting in an increased rate of readmission or urgent care visits.

AB - Introduction: We evaluated the safety and efficacy of a clinical pathway designed and implemented to transition inpatient minimally invasive radical prostatectomy to a procedure with overnight observation. Methods: In April 2011 ambulatory extended recovery was implemented at our institution. This was a multidisciplinary program of preoperative teaching and postoperative care for patients undergoing minimally invasive radical prostatectomy. We compared the risk of requiring a more than 1-night hospital stay by patients treated with surgery the year before the program vs those treated after the program was initiated, adjusting for age, ASA® status and surgery type. We also examined the rates of readmission and urgent care visits within 48 hours, and 7 and 30 days before and after the program began. Results: The proportion of patients who stayed longer than 1 night was 53% in the year before initiating the ambulatory extended recovery program vs 8% during the program, representing an adjusted absolute risk decrease of 45% (95% CI 39-50, p <0.0001). There was no important predictor of a greater than 1-night length of stay among ambulatory extended recovery patients. Rates of readmission and urgent care visits were slightly lower during the ambulatory extended recovery phase with no significant difference between the groups. Conclusions: The ambulatory extended recovery program successfully transitioned most patients to a 1-night hospital stay without resulting in an increased rate of readmission or urgent care visits.

KW - Critical pathways

KW - Laparoscopy

KW - Length of stay

KW - Prostate

KW - Prostatectomy

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