Trends in immediate perioperative morbidity and delay in discharge after open and minimally invasive radical prostatectomy (RP): a 20-year institutional experience

摘要: What's known on the subject? and What does study add? Standard clinical care pathways to discharge have been established for a number of operations including radical prostatectomy (RP). The pathway after RP has changed dramatically over past two decades due improvements in surgical technique, anaesthesia most recently, introduction minimally invasive (MIRP). This adds evidence that emergence MIRP is associated with decrease LOS all patients undergoing RP. In addition, it catalogues development 20 years at large, tertiary hospital extensive experience Finally, defines common reasons fall ‘off-pathway’ (ileus, urine leak, anaemia re-exploration bleeding) immediate perioperative morbidity profile Specifically, addresses approach-specific morbidities indicates higher rates discharge, often ileus. Objective To investigate (RP) academic medical centre years, focusing deviation. Patients Methods In all, 18 049 men were identified from Johns Hopkins database who had undergone surgery since 1991. Patients whom length stay (LOS) was ≤95th percentile, defined those ≥98th percentile termed ‘off-pathway’. Results The mean decreased 7.7 days 1991 1.6 2010. Of 7126 2005, 1803(25.3%), 4881(68.5%) 312 (4.4%) discharged postoperative day (POD) 1, 2 3, respectively; 126 (1.8%) patients, POD4–21 ‘off-pathway’. The delay ileus (44, 0.615%), leak (12, 0.17%), requiring blood transfusion (nine, 0.126%) bleeding (six, 0.08%). The proportion 1.20%, 1.06% 4.01% retropubic (RRP), laparoscopic (LRP) robot-assisted (RALRP), respectively (P < 0.001). Ileus delayed 0.28%, 0.37% 1.9% RRP, LRP RALRP, 0.001). Conclusions The our institution years. RALRP appears result primarily ileus, compared RRP LRP. However, very few ‘off-pathway’.