ADULT UROLOGY ELSEVIER PATIENT SATISFACTION WITH SHORT STAYS FOR RADICAL PROSTATECTOMY MARK S. LITWIN, ANDREW I. SHPALL, AND FREDERICK DOREY ABSTRACT Objectives. We evaluated the effects on patient satisfaction of shortened postoperative hospital stays after radical retropubic prostatectomy {RRP}. Methods. A previously validated, self-administered instrument was used to assess satisfaction with care in a retrospective, cross-sectional study of 129 men who had undergone RRP after implementation of a short- stay clinical care pathway. Health-related quality of life outcomes, comorbidity, and sociodemographic data were also measured with established instruments. Results. Satisfaction with care was uniformly high and did not vary with length of stay (LOS), time since surgery, or health-related quality of life. Conclusions. Decreased LOS mandated by the need for a cost-efficiency path does not adversely affect patient satisfaction. UROLOGY 49: 898-906, 1997. © 1997, Elsevier Science Inc. All rights reserved. W ith the advent of managed care and pro- spective payment systems for hospital med- ical services, intense financial incentives have led to increasingly shorter hospital stays. This has been particularly true for patients undergoing elective surgery, where standardization of care has been instituted to eliminate the waste associated with variations in physician practice patterns. Pre- viously, we demonstrated that a clinical care path- way for radical prostatectomy could be used to achieve significant cost savings, primarily by shortening postoperative length of stay (LOS). 1 Other researchers have also published critical care pathways and shown similar results. 2-6 As LOS has diminished to previously unattainable levels, in- vestigators have begun to wonder whether patient satisfaction with care will suffer. Yet in the current era of austerity in health care, this issue has been largely overlooked. Although various investigators have examined this topic, none has used estab- lished, validated instruments to formally measure patient satisfaction. From the Departments of Urology and Health Services, Schools of Medicine and Public Health; and Department of Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, California Reprint requests: Mark S. Litwin, M.D., M.P.H., UCLA De- partment of Urology, Box 951 738, Los Angeles, CA 90095-1738 Submitted: October 25, 1996; accepted (with revisions): De- ~ember 11, 1996 © 1997, ELSEVIER SCIENCE INC. 898 ALL RIGHTS RESERVED Satisfaction with care is a patient-centered med- ical outcome, which, like health-related quality of life (HRQOL), is assessed and reported directly by patients, rather than by objective observers. Assess- ment of patient satisfaction involves the evaluation of attitudes toward distinct dimensions of health care TM and includes patients' global impressions of their care, as well as their satisfaction with specific domains, such as building facilities and atmo- sphere, nursing or physician care, and hospital bill- ing. Patient satisfaction derives from perceived dif- ferences between expectations and experience. 9 Fulfilling the directive for more stringent cost- containment in surgery has been accomplished primarily by decreasing average postoperative LOS. I° Yet the maintenance of a consistently high standard for patient satisfaction in the presence of these forces is an imposing challenge. Although shorter postoperative hospital stays have been shown not to result in greater rates of complica- tions or readmissions, 1 it is not well established whether decreased LOS has diminished patient satisfaction. We sought to answer this question by using an established, validated instrument to survey a large group of men who had recently experienced early discharge after radical retropubic prostatectomy for localized prostate cancer. In particular, we wondered whether in our zeal to achieve cost sav- ings through early discharge, we had adversely af- fected patient satisfaction with care. 0090-4295/97/$17.00 PlI S0090-4295(97)00103-9