Standardized follow-up program may reduce emergency room and urgent care visits for patients undergoing radical prostatectomy

Authors

  • Ryan Kendrick Flannigan University of British Columbia
  • Geoffrey T. Gotto University of Calgary, Southern Alberta Institute of Urology
  • Bryan Donnelly Southern Alberta Institute of Urology and The Division of Urology, Department of Surgery, University of Calgary
  • Kevin V. Carlson Vesia [Alberta Bladder Centre], Southern Alberta Institute of Urology and The Division of Urology, Department of Surgery, University of Calgary,

DOI:

https://doi.org/10.5489/cuaj.1655

Keywords:

Prostate Cancer, Radical Prostatectomy, Morbidity, Quality Assurance

Abstract

Introduction: The objective of the current study was to determine the impact of a standardized follow-up program on the morbidity and rates of hospital visits following radical prostatectomy (RP) in a tertiary, non-teaching urologic centre.

Methods: Patients who underwent a RP in 2008 were retrospectively evaluated in this study. Postoperative morbidity for the entire cohort was assessed using the Modified Clavien Scale (MCS). Those patients readmitted to hospital or who visited an urban or rural emergency department (ED) within 90 days of surgery were further evaluated to determine the reason for readmission.

Results: At our centre, 321 patients underwent RP in 2008 by 11 surgeons. Of the 321 patients, 77 (24.0%) visited an ED within 90 days, and 14 were readmitted to hospital, with an additional patient readmitted directly (with a total 15 readmissions, 4.7% overall). No patients died within the study period. In 2009 we launched a pilot study wherein 115 RP patients received scheduled and on-demand follow-up care by a dedicated nurse between May and November. We found that 90-day readmission rates among this cohort dropped to 5% and 2.6% for ED visits and hospital readmission, respectively.

Conclusions: At our tertiary non-teaching centre, a significant number of patients presented back to hospital within 90 days following RP. Most of these patients (80.8%) were managed entirely through an outpatient ED, and many visits were for routine postoperative care. Only 18.2% (4.7% of the 321 prostatectomy patients) were readmitted to hospital. These data point to a need for enhanced postoperative support of patients to reduce costly and often unnecessary visits to acute care EDs. This conclusion is supported by our early experience. Limitations include retrospective design, and variability in practice of surgeons in this study.

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Author Biographies

Ryan Kendrick Flannigan, University of British Columbia

Department of Urology, Resident

Geoffrey T. Gotto, University of Calgary, Southern Alberta Institute of Urology

Division of Urology, Department of Surgery, Clinical Assistant Professor

Bryan Donnelly, Southern Alberta Institute of Urology and The Division of Urology, Department of Surgery, University of Calgary

Clinical Associate Professor

Kevin V. Carlson, Vesia [Alberta Bladder Centre], Southern Alberta Institute of Urology and The Division of Urology, Department of Surgery, University of Calgary,

Director, vesia [Alberta Bladder Centre]
Division Chief of Urology, University of Calgary

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Published

2014-07-18

How to Cite

Flannigan, R. K., Gotto, G. T., Donnelly, B., & Carlson, K. V. (2014). Standardized follow-up program may reduce emergency room and urgent care visits for patients undergoing radical prostatectomy. Canadian Urological Association Journal, 8(7-8), e505–9. https://doi.org/10.5489/cuaj.1655

Issue

Vol. 8 No. 7-8 (2014): CUAJ July

Section

Original Research

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