Radical retropubic prostatectomy outcomes at a community hospital

Gaylis FD; Friedel WE; Armas OA
J Urol 1998;159(1):167-71

Department of Urology, Grossmont Hospital, La Mesa, California, USA.

PURPOSE: We reviewed a 6-year experience performing radical
retropubic prostatectomy at 2 community hospitals (for-profit and
not-for-profit) to assess outcomes and to compare them to the
published literature reflecting outcomes from major academic
hospitals. MATERIALS AND METHODS: Charts of 116 patients who
underwent radical retropubic prostatectomy (nerve sparing in select
cases) between 1990 and 1996 were reviewed for clinical and
pathological outcomes as well as hospital charges. Subjective patient
reports of urinary continence, potency and satisfaction were
evaluated postoperatively. RESULTS: Average patient age was 66.6
years and average preoperative prostate specific antigen level was
9.6 ng./ml. Of the patients 43% had T1c disease, 63% pT2 and 37% pT3.
Positive margins were present in 17.2% of the specimens and 66% of
the patients had Gleason scores of 5 and 6. No deaths occurred. Major
complications occurred in 5.4% of patients and included deep venous
thrombosis (1.8%), pulmonary embolism (1.8%), rectal injury requiring
ileostomy (0.9%) and fascial dehiscence (0.9%). Mean blood loss was
872 cc and mean blood transfusion rate was 1.7 units (almost
exclusively autologous blood). Hospital charges decreased at the
not-for-profit hospital to $13,233 in 1996 from $17,743 in 1990 to
1995, whereas charges increased at the for-profit hospital to $25,979
in 1996 from $24,481 in 1990 to 1995. Mean length of stay decreased
from 5 days in 1990 to 1995 to 3 days in 1996. Of the patients 80%
were totally continent (pad-free), 12% wore a protective pad once per
day for minimal incontinence and 8% wore 2 or more pads. Of the men
who were potent preoperatively 18% retained potency and 46% remained
sexually active postoperatively either spontaneously or with
assistance. Of the patients 84% were satisfied with surgical
outcomes, 11% were somewhat satisfied and 5% were dissatisfied.
CONCLUSIONS: Radical retropubic prostatectomy can be performed safely
and with acceptable clinical and pathological outcomes at a community
hospital. Impotence continues to be one of the most bothersome
morbidities, particularly in older men. Increasing cost awareness,
coincident with the proliferation of managed care, has led to
reductions in length of hospital stay and charges at certain
hospitals. (14 Refs)