Ambulatory Robot-Assisted Laparoscopic Prostatectomy: Is It Ready for Prime Time? A Quality of Life Analysis

Bajpai, Rajesh Raj; Razdan, Shirin; Barack, Justin; Sánchez, Mabel; Razdan, Sanjay

doi:10.1089/end.2019.0261

Cited by 22 publications

(25 citation statements)

References 21 publications

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“…Quality of life after RARP has not been well compared between SDD and inpatient surgery. Nevertheless, Bajpai et al demonstrated that SDD had a positive impact on pain, general activity, and perceived overall health two days after discharge compared with next day discharge [21]. Second, no randomization was done, which may introduce selection biases between SDD and inpatient cases although the exclusion of inpatient surgeries in men who did not fulfill the SDD criteria reduced that risk.…”

Section: Discussionmentioning

confidence: 99%

Same Day Discharge versus Inpatient Surgery for Robot-Assisted Radical Prostatectomy: A Comparative Study

Rahota

Salin

Gautier

et al. 2021

JCM

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(1) Background: no study has compared outcomes of same day discharge (SDD) versus inpatient robot-assisted radical prostatectomy (RARP) in homogenous cohorts. Our aim was to compare perioperative outcomes and urinary continence recovery between SDD and inpatient RARP in contemporary, comparable patients. (2) Methods: we included consecutive patients undergoing RARP between 2018 and 2020 (n = 376). Only patients eligible for SDD (no oral anticoagulant, distance home-hospital <150 km) and having >6-month follow-up were included (n = 180). All patients underwent RARP with or without lymph node dissection. Comparisons were performed between SDD (n = 42) and inpatient RARP (n = 138). Primary outcomes were 90-day complication and readmission rates and continence rates at 1 and 6 months. (3) Results: median patient age was 66.7 years. Median duration of surgery and blood loss was 134 min and 200 mL, respectively. Lymph node dissection and nerve-sparing procedures were performed in 76.7% and 82.2% of cases, respectively. Median follow-up was 19.5 months. No difference was seen regarding patient features, peri-operative outcomes, and pathology parameters between both groups. The proportion of SDD RARP was stable over time (23.5%). The 90-day unplanned visits, readmission and complication rates were 9.5%, 7.1%, and 19.0% in SDD patients versus 14.5% (p = 0.407), 10.1% (p = 0.560), 28.3% (p = 0.234) for inpatient RARP, respectively. Trends favoring SDD were not statistically significant. Continence rates at 1-(p = 0.589) and 6-months (p = 0.674) were comparable between SDD and inpatient RARP. The main limitation was the lack of randomization. (4) Conclusions: this multi-surgeon comparative study confirms the safety of routine SDD RARP in terms of perioperative and functional outcomes. Trends favoring SDD in terms of complications, emergency visits and readmission have to be confirmed.

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Section: Discussionmentioning

confidence: 99%

Same Day Discharge versus Inpatient Surgery for Robot-Assisted Radical Prostatectomy: A Comparative Study

Rahota

Salin

Gautier

et al. 2021

JCM

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“…In recent years, several high-volume surgeons have reported the safety of same-day discharge (SDD) after RALP [4,5]. There are several arguments supporting this practice.…”

Section: Introductionmentioning

confidence: 99%

“…Second, avoiding hospitalization may expedite the recovery process. Bajpai et al found that patients discharged the day of surgery had less pain, less interference with general activities and better-perceived overall health than those who stayed overnight [5]. Third, SDD decreases the risk of nosocomial infections and hospital error.…”

Section: Introductionmentioning

confidence: 99%

Rethinking the need for overnight admission after robotic-assisted laparoscopic prostatectomy

et al. 2020

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Robotic-assisted laparoscopic prostatectomy (RALP) is the gold standard for the surgical management of localized prostate cancer (PCa). Multi-institutional series have demonstrated complications and readmissions in less than 5% of patients and most are now discharged within 24 h of surgery. Recently, several high-volume surgeons demonstrated the safety of sameday discharge (SDD) after RALP. The main benefits include lower costs and reduced exposure to nosocomial infections and hospital errors. The leading arguments for criticism include potential suboptimal postoperative care and the risk of missing a catastrophic event. In recent years, important advances have further strengthened the argument for SDD including more structured perioperative care, integration of single-port robotic systems, and new challenges presented by the coronavirus 2019 (COVID-19) pandemic. Here, we provide further evidence demonstrating the safety of SDD in a multi-institutional cohort of patients and review the main arguments supporting the expanded use of this approach.

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“…This has led to wider acceptance of same-day-discharge (SDD) surgery [3] , [4] . However, to date, only a few large series, mainly from single centers, have been reported, and there are no countrywide data regarding the safety and utilization of SDD RARP in routine practice [5] .…”

mentioning

confidence: 99%

Same-day-discharge Robot-assisted Radical Prostatectomy: An Annual Countrywide Analysis

Ploussard

Grabia

Barret

et al. 2022

European Urology Open Science

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There are no countrywide data regarding the utilization of same-day-discharge (SDD) surgery for robot-assisted radical prostatectomy (RARP). We aimed to evaluate the annual number of SDD RARP procedures in France and to compare postoperative outcomes in SDD versus non-SDD centers. Data for all 9651 patients undergoing RARP in France in 2020 were extracted from the central database of the national healthcare system. Endpoints were length of hospital stay, patient age, center volume, lymph node dissection, and the hospital readmission rate. Overall, 184 SDD cases (1.9%) were reported in 14.2% of RARP centers. The annual RARP and SDD RARP caseload ranged from 41 to 485, and from one to 47, respectively, in SDD centers. SDD was significantly associated with higher-volume centers ( p < 0.001). No difference in readmission rate (7.9% vs 5.1%; p = 0.141) was observed for SDD versus non-SDD centers. Direct stay costs were estimated at €1457 in SDD centers compared to €2021 in non-SDD centers. The main limitation is the lack of detailed patient characteristics and readmission causes. This annual nationwide analysis suggests that SDD RARP remains infrequently used in routine practice in France despite being associated with comparable short-term outcomes after RARP and potential cost benefits. Patient summary We evaluated the use of robot-assisted removal of the prostate (RARP) with same-day hospital discharge in France for men with prostate cancer. In 2020, only 1.9% of the 9651 RARP procedures involved same-day discharge, even though the data show that this approach has lower costs and comparable safety.

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Ambulatory Robot-Assisted Laparoscopic Prostatectomy: Is It Ready for Prime Time? A Quality of Life Analysis

Cited by 22 publications

References 21 publications

Same Day Discharge versus Inpatient Surgery for Robot-Assisted Radical Prostatectomy: A Comparative Study

Same Day Discharge versus Inpatient Surgery for Robot-Assisted Radical Prostatectomy: A Comparative Study

Rethinking the need for overnight admission after robotic-assisted laparoscopic prostatectomy

Same-day-discharge Robot-assisted Radical Prostatectomy: An Annual Countrywide Analysis

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