Enhanced recovery pathway for radical prostatectomy: Implementation and evaluation in a universal healthcare system

  • Hiba Abou-Haidar McGill University
  • Samuel Abourbih
  • David Braganza
  • Talal Al Qaoud
  • Lawrence Lee
  • Franco Carli
  • Deborah Watson
  • Armen G. Aprikian
  • Simon Tanguay
  • Liane S. Feldman
  • Wassim Kassouf
Keywords: enhanced recovery pathway, standardization of care, prostate cancer, radical prostatectomy, outcomes


Introduction: Enhanced recovery pathways are standardized, multidisciplinary, consensus-based tools that provide guidelines for evidence-based decision-making. This study evaluates the impact of the implementation of a clinical care pathway on patient outcomes following radical prostatectomy in a universal healthcare system.

Methods: Medical charts of 200 patients with prostate cancer who underwent open and minimally invasive radical prostatectomy at a single academic hospital from 2009 to 2012 were reviewed. A group of 100 consecutive patients’ pre-pathway implementation was compared with 99 consecutive patients’ post-pathway implementation. Duration of hospital stay, complications, post-discharge emergency department visits and readmissions were compared between the 2 groups.

Results: Length of hospital stay decreased from a median of 3 (interquartile range [IQR] 4 to 3 days) days in the pre-pathway group to a median of 2 (IQR 3 to 2 days) days in the post-pathway group regardless of surgical approach (p < 0.0001). Complication rates, emergency department visits and hospital readmissions were not significantly different in the pre- and post-pathway groups (17% vs. 21%, p = 0.80; 12% vs. 12%, p = 0.95; and 3% vs. 7%, p = 0.18, respectively). These findings were consistent after stratification by surgical approach. Limitations of our study include lack of assessment of patient satisfaction, and the retrospective study design.

Conclusions: The implementation of a standardized, multidisciplinary clinical care pathway for patients undergoing radical prostatectomy improved efficiency without increasing complication rates or hospital readmissions.


How to Cite
Abou-Haidar, H., Abourbih, S., Braganza, D., Al Qaoud, T., Lee, L., Carli, F., Watson, D., Aprikian, A., Tanguay, S., Feldman, L., & Kassouf, W. (2014). Enhanced recovery pathway for radical prostatectomy: Implementation and evaluation in a universal healthcare system. Canadian Urological Association Journal, 8(11-12), 418-23. https://doi.org/10.5489/cuaj.2114
Original Research