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„Fast-track“ bei laparoskopisch radikaler Prostatektomie

Fast-track laparoscopic radical prostatectomy

Der Urologe volume 47, pages 712–717 (2008)Cite this article

Zusammenfassung

Hintergrund

„Fast-track-Chirurgie“ beschreibt den Zusammenschluss perioperativer Behandlungsstrategien, die in einer schnelleren Rekonvaleszenz des Patienten nach einem chirurgischem Eingriff resultieren. Ziel dieser Studie war die Evaluation der Entlassungsfähigkeit und Komplikationsrate der Patienten nach einem neu etabliertem Fast-track-Konzept 3 Tage nach einer laparoskopsich radikalen Prostatektomie.

Patienten und Methoden

In jeweils einer Therapiegruppe wurden 25 Patienten randomisiert und nach konventionellen oder Fast-track-Kriterien behandelt. Es wurden perioperative Daten, Komplikationen, Aufenthaltsdauer und die Wiederaufnahmerate erhoben. Alle Patienten erhielten überdies ein kurzes Interview zur persönlichen Einschätzung des erhaltenen therapeutischen Regimes und zur Feststellung der allgemeinen perioperativen Zufriedenheit.

Ergebnisse

Die mittlere postoperative Aufenthaltsdauer in der Fast-track-Gruppe betrug 3,6 Tage gegenüber 6,7 Tage in der konventionellen Gruppe (p<0,01). Die Komplikationsrate in der Fast-track-Gruppe war signifikant geringer, die Wiederaufnahmerate war in beiden Gruppen ebenfalls gering und nicht signifikant unterschiedlich. Die allgemeine perioperative Zufriedenheit der Patienten war unter dem Fast-track-Konzept signifikant höher, die subjektiven Einschätzungen der Therapie durch die beiden Patientengruppen unterschieden sich hingegen nicht signifikant.

Schlussfolgerungen

Fast-track-Verfahren sind gut auf die laparoskopisch radikale Prostatektomie übertragbar. Sowohl Patienten als auch die ausführende Klinik können von einem funktionierendem Fast-track-Konzept im Rahmen der laparoskopisch radikalen Prostatektomie profitieren.

Abstract

Background

Fast-track surgery describes perioperative treatment concepts ensuring a faster postoperative convalescence phase. By using a multimodal fast-track concept in patients undergoing laparoscopic radical prostatectomy, we aimed to investigate the feasibility of this procedure after elective surgery and a possible discharge 3 days postoperatively.

Patients and methods

Twenty-five patients per group were randomized for conventional or fast-track treatment, respectively. Perioperative data, early complications, possible hospital discharge, and readmission rate were analyzed. Before hospital discharge, all patients were interviewed about their evaluation of the received regimen and their overall satisfaction perioperatively.

Results

The mean postoperative hospital stay was 3.6 days in the fast-track group vs. 6.7 days in the conventional group (p<0.01). Overall complications were low but were significant between the two groups, with the fast-track procedure being more favorable. Readmission rate was also low but was not significant. Overall satisfaction was significantly higher in the fast-track group, whereas the subjective evaluation did not differ between the two regimens.

Conclusions

Fast-track concepts are well transferable in laparoscopic radical prostatectomy settings. Patients receiving this procedure, as well as clinics offering it, may benefit from a suitable fast-track concept.

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Affiliations

  1. Klinik für Urologie, Klinikum der Universität zu Köln, Kerpener Straße 62, 50924, Köln, Deutschland

    O. Gralla

  2. Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    M. Buchser, F. Haas, E. Anders, J. Kramer & M. Lein

  3. Institut für Medizinische Psychologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    N. Knoll

  4. Klinik für Urologie, Klinik am Urban, Berlin, Deutschland

    J. Roigas

Authors
  1. O. Gralla
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  2. M. Buchser
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  3. F. Haas
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  4. E. Anders
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  5. J. Kramer
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  6. M. Lein
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  7. N. Knoll
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  8. J. Roigas
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Correspondence to O. Gralla.

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Gralla, O., Buchser, M., Haas, F. et al. „Fast-track“ bei laparoskopisch radikaler Prostatektomie. Urologe 47, 712–717 (2008). https://doi.org/10.1007/s00120-008-1688-3

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  • DOI: https://doi.org/10.1007/s00120-008-1688-3

Schlüsselwörter

  • Laparoskopisch radikale Prostatektomie
  • Fast-track
  • Komplikationen
  • Patientenzufriedenheit
  • Aufenthaltsdauer

Keywords

  • Laparoscopic radical prostatectomy
  • Fast-track
  • Complications
  • Patient satisfaction
  • Hospital length of stay