Potential for new standard of care seen with 24-hour stay using
epidural, non-narcotic pain relief
originally posted on June 6, 2001
ANN ARBOR, MI - No one likes to be in the
hospital longer than needed. Now, a new approach to prostate
cancer surgery using a combination of existing techniques
may help men get home within 24 hours of having their prostates
removed - without making them less satisfied with their care
or putting them at extra risk of complications.
That finding, from a study comparing a "fast track" prostate
surgery pathway with a standard approach that keeps patients
in the hospital for up to three days, was presented this week
at the American Urological Association's annual meeting in
Anaheim, CA by researchers from the University of Michigan
Comprehensive Cancer Center. It's the first study of its kind.
The U-M's 24-hour approach stood up to the prospective comparison
well, yielding high patient satisfaction rates and low complication
rates almost exactly like those seen with standard care, says
senior author Martin Sanda, M.D., an associate professor of urology at the
Medical School and associate director of the U-M Health
System's prostate cancer
Sanda and his colleagues devised the pathway, which uses
epidural anesthesia, non-narcotic pain relief and tailored
patient education materials to help early-stage prostate cancer
patients get home sooner, just as safely, and with less expense.
They then compared it prospectively with standard care in
153 patients operated on in the year 2000 by two U-M surgeons.
"Our findings suggest a possible new standard of care that
would lead to a 24-hour stay for most patients, if their surgery
is performed at centers specializing in prostate cancer care,"
Sanda says. "Since prostatectomy is the most common treatment
for early-stage prostate cancer, and indeed is one of the
most common cancer operations overall, a more streamlined
approach could have a major impact on both patient experience
and cost of care."
The U-M pathway doesn't rely on any brand-new advance - just
coordinated use of a lower-body epidural anesthesia approach
that avoids the "hangover" effect of general anesthesia, non-narcotic
pain drugs such as ketorolac and ibuprofen that let the patient
be more alert and active soon after surgery, and specially
developed education materials to help the patient and his
loved ones know what to expect regarding post-operative care
and at-home self care.
Just by combining these elements and making a determined
effort to offer the patient the option to go home after 24
hours, the U-M team was able to send 77 percent of patients
home after one day's stay, while maintaining a satisfaction
rate of 94 percent and a post-operative complication rate
of about 5 percent. These two rates almost exactly matched
the rates for patients receiving standard care. Long-term
outcomes have also been favorable.
Other advantages to the new pathway included the decreased
use of narcotic pain relievers, which in most cases were discontinued
on the same day as surgery, and increased involvement of the
patient and his spouse or family member in the post-operative
period. The two go hand in hand, as patients who are off narcotic
medication can take a more active role in caring for themselves.
The new pathway is becoming the standard for many early-stage
prostate cancer patients at the U-M Cancer Center. Sanda hopes
it will help other centers determine whether they can streamline
care for their patients.
"No one has looked at how perioperative and postoperative
care can be optimized, to reduce the length of hospital stay
while maintaining patient-reported satisfaction," Sanda explains.
"This study indicates we can keep the patient happy and comfortable,
and give him the option of going home earlier, with a proactive,
But, he adds, no patient was shoved out the door just to
cut the length of their hospital stay. "Fast track" patients
who elect to stay longer are always allowed to do so.
"None of our patients reported feeling rushed, and no one
was forced out; the option to leave at 24 hours is just that,
an option, and not a requirement or expectation." Sanda emphasizes.
"Nevertheless, most patients given this option did indeed
choose to go home early and were medically well enough to
The study's other authors are urology resident Stephanie
Kielb, M.D., who presented the results in a poster at the
AUA meeting; research associate Jennifer Resh; and James Montie,
M.D., Valassis Professor of Urologic Oncology and head of
the section of urology in the U-M Medical School's Department
This research was funded in part by a National Cancer Institute
Prostate Cancer SPORE
(Specialized Program of Reseach Excellence) grant to the University
For information on prostate cancer care at the U-M Comprehensive
Cancer Center, please call the Cancer Answer Line at 800-865-1125.
Written by Kara Gavin
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