Johann P Ingimarsson1, Benjamin W Herrick2, Ronald L Yap3. 1. Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: johann.p.ingimarsson@hitchcock.org. 2. Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 3. Concord Hospital Center for Urological Care, Concord, NH.
Abstract
OBJECTIVE: To assess readmissions, complications, and outcomes of a rapid ambulatory discharge pathway (RADP) in high anesthetic risk patients who have undergone laser prostate surgery. METHODS: Medical records of patients who underwent holmium laser ablation of the prostate between 2007 and 2012 by a single surgeon were retrospectively reviewed. Patients with American Society of Anesthesiologists category ≥3 ("severe systemic disease") were included. All patients were scheduled for a rapid ambulatory discharge pathway, which involved discharge on the day of surgery with a urethral catheter, with a voiding trial on postoperative day 3. RESULTS: Fifty-seven patients met the inclusion criteria. Fifty patients (88%) were successfully discharged on rapid ambulatory discharge pathway. Six patients (11%) were later readmitted for hematuria (3), urinary retention (1), or cardiac events (2). Two patients (4%) had emergency department visits for catheter-related problems. Increasing length of surgery, increasing amount of laser energy used, and a surgical indication indicative of more advanced disease were associated with postoperative hospitalization and readmissions on univariate analysis. No patient operated on for lower urinary tract symptoms was hospitalized or needed a readmission. The mean change in International Prostate Symptom Score and quality of life at 3 months were -12.5 ± 8.2 (P <.001) and -2.6 ± 1.7 (P <.001), respectively. CONCLUSION: It is safe to use a rapid ambulatory discharge pathway for laser prostatectomy in high anesthetic risk patients with good short-term outcomes, especially in men operated on for lower urinary tract symptoms.
OBJECTIVE: To assess readmissions, complications, and outcomes of a rapid ambulatory discharge pathway (RADP) in high anesthetic risk patients who have undergone laser prostate surgery. METHODS: Medical records of patients who underwent holmium laser ablation of the prostate between 2007 and 2012 by a single surgeon were retrospectively reviewed. Patients with American Society of Anesthesiologists category ≥3 ("severe systemic disease") were included. All patients were scheduled for a rapid ambulatory discharge pathway, which involved discharge on the day of surgery with a urethral catheter, with a voiding trial on postoperative day 3. RESULTS: Fifty-seven patients met the inclusion criteria. Fifty patients (88%) were successfully discharged on rapid ambulatory discharge pathway. Six patients (11%) were later readmitted for hematuria (3), urinary retention (1), or cardiac events (2). Two patients (4%) had emergency department visits for catheter-related problems. Increasing length of surgery, increasing amount of laser energy used, and a surgical indication indicative of more advanced disease were associated with postoperative hospitalization and readmissions on univariate analysis. No patient operated on for lower urinary tract symptoms was hospitalized or needed a readmission. The mean change in International Prostate Symptom Score and quality of life at 3 months were -12.5 ± 8.2 (P <.001) and -2.6 ± 1.7 (P <.001), respectively. CONCLUSION: It is safe to use a rapid ambulatory discharge pathway for laser prostatectomy in high anesthetic risk patients with good short-term outcomes, especially in men operated on for lower urinary tract symptoms.