Factors Influencing Time To Resume Activity Following Open Radical Prostatectomy Are Identified

According to a report by Dr. Herbert Lepor in the October 2006 issue of the Journal of Urology, higher discharge hematocrit and early post-operative Foley catheter removal are two factors strongly associated with resumption of normal activity following radical prostatectomy.

Between 2002 and 2005 537 prostate cancer (CaP) patients undergoing open radical prostatectomy (RP) by Dr. Lepor at New York University were including in the study cohort. All men with a pre-operative hematocrit of 48% or less were encouraged to receive 2 preoperative injections of recombinant erythropoietin. Hematocrit was followed throughout the perioperative course and gravity cystograms were performed on day 8. Men were counseled that they could resume unrestricted physical activity on postoperative day 21, but time to return to work was left to the discretion of the individual. A urology nurse specialist interviewed all participants on day 30 to determine when they had returned to part-time or full-time work and unlimited physical activity. These questions were again assessed with a 3-month self-reported questionnaire.

Fifty percent of study participants returned to part-time and full-time work and unrestricted activity within 14, 21 and 30 days after hospital discharge. Patient age, time of urinary catheter removal and discharge hematocrit was related to time to return to part-time work. For every year increase in age the number of days to return to part-time work decreased by 0.30 days. For every unit increase in discharge hematocrit, the number of days to return to part-time work decreased by 0.50 days. Men in whom the urinary catheter was indwelling >15 days returned to part-time work an average of 15 days later.

Return to full-time work was predicted by age, martial status occupation and discharge hematocrit. For every year increase in age, the number of days to return to full-time work decreased by 0.64 days. The thought was that younger men are presumably engaged in more physically demanding employment. For every unit increase in discharge hematocrit the number of days to return to full-time work decreased by 0.6 days. Married men returned to full-time work an average of 6.7 days earlier than unmarried men and white-collar men returned to full-time work an average of 8.5 days earlier than blue-collar workers.

The odds of returning to work in less than 14 days if hematocrit is greater than 32% are 1.5 times as great as the odds of returning to work in less than 14 days if hematocrit is less than 33%. The authors note that resumption of activity may be attributed to physician emphasis on return to unrestricted rather than normal activity.

By Christopher P. Evans, M.D.

J Urol 2006;179(4):1420-23
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