A multi-center study for standardisation of perioperative management of radical prostatectomy using clinical pathways

Abstract

(Purpose) Our previous study indicated that there was a great variety in the perioperative management of radical prostatectomy among hospitals. Therefore we conducted a multi-institutional study in order to standardize the perioperative management using clinical pathways. (Materials and methods) The perioperative data on radical prostatectomy were collected between January and December 2004 (Period 1) from eight hospitals. These outcomes were discussed by researchers and the clinical pathway used at each hospital was constructed or revised. The outcomes using these pathways in Period 2 (January 2005 to March 2006) were compared with those in Period 1. (Results) Three hundred seventy-eight men in Period 1 and 360 in Period 2 were enrolled in this study. The settings of perioperative management using the new pathways were relatively similar among hospitals. A majority of perioperative management procedures in Period 2 were conducted as described in the new clinical pathways, judging from the median days. The day of initiating the resumption of fluid intake, meals and removing the epidural anesthetic catheter and drain changed from 1.2 ± 0.7 to 1.3 ± 1.4 postoperative day, 1.9 ± 1.2 to 1.8 ± 1.7, 2.4 ± 0.7 to 2.5 ± 0.6, 3.8 ± 2.5 to 3.8 ± 2.8, respectively, without a significant difference. The postoperative day of initiating the walking and discontinuing continuous drip infusion and intravenous antibiotics were shortened from 1.9 ± 0.9 to 1.5 ± 0.6, 3.7 ± 2.1 to 3.1 ± 2.2 and 3.6 ± 2.0 to 2.5 ± 2.2, respectively, which did show a significant difference. The day of removing the urethral catheter was changed 9.1 ± 4.9 to 8.6 ± 5.4 without significant difference. But the durations of preoperative hospitalization, hospitalization after removing the urethral catheter and postoperative hospitalization were significantly shortened from 3.4 ± 2.1 to 2.5 ± 1.0 days, 8.9 ± 10.1 to 5.6 ± 3.8, and 17.9 ± 10.9 to 14.4 ± 9.1, respectively. (Conclusions) The clinical pathways established or revised at these hospitals after discussing the perioperative management in multiple hospitals were similar, and using such pathways advanced the standardization of peri-operative management after radical prostatectomy.