A MULTI-CENTER STUDY FOR STANDARDISATION OF PERIOPERATIVE MANAGEMENT OF RADICAL PROSTATECTOMY USING CLINICAL PATHWAYS
| Autor: | Mutsushi Kawakita, Yoshikatsu Nojiri, Osamu Kamihira, Hidehisa Soejima, Kikuo Okamura, Tatsuya Nagai, Kazuhiro Okumura, Akito Terai, Tomoyasu Tsushima, Shiro Saito |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment Perioperative Care Fluid intake Clinical pathway Humans Medicine Aged Prostatectomy Perioperative management business.industry Perioperative Length of Stay Middle Aged Anti-Bacterial Agents Hospitalization Catheter Treatment Outcome Anesthesia Multi center study Critical Pathways Urinary Catheterization business Drip infusion |
| Zdroj: | The Japanese Journal of Urology. 100:563-569 |
| ISSN: | 1884-7110 0021-5287 |
| Popis: | PURPOSE Our previous study indicated that there was a great variety in the perioperative management of radical prostatectomy among hospitals. Therefore we conducted a multiinstitutional 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. |
| Databáze: | OpenAIRE |
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