Outpatient vs Inpatient Single-Port Robotic Urologic Surgery: Perioperative Outcomes and Complications

Abstract

Introduction:The da Vinci Single Port (SP) robotic surgical system has minimized the impact of surgery on patients. Hence, outpatient robotic procedures are being explored to reduce costs and improve patient experience. Here, we evaluate the perioperative outcomes and safety of same-day discharge (SDD) after surgery compared to inpatient procedures using the SP.Methods: A total of 374 patients underwent surgery with the da Vinci SP system between January 2019 and February 2023. Surgeries were performed in a single high-volume center. Patients were either managed with a standardized outpatient or inpatient protocol. SDD clinical pathway was implemented in June 2021. Patients were assessed for discharge eligibility based on specific guidelines. Detailed instructions were provided at discharge, and patients were followed postoperatively. Baseline characteristics, perioperative data, complications, time to complication, and readmissions were assessed.Results: Two hundred eight patients underwent outpatient surgery and 166 underwent inpatient surgery (total ¼ 374). Outpatient surgery was not associated with increased postoperative complications and readmission compared to inpatient surgery. Ninety percent and 74.6% of patients experienced no complications in the outpatient and inpatient populations, respectively (P ¼< .001). Time to first complication was also comparable between the 2 groups (3 days [IQR 1-8] vs 10 days for outpatient vs inpatient; P ¼ .3). The proportion of successful SDDs increased over time, reaching 88% in October 2022.Conclusions: Outpatient surgery using the da Vinci SP is safe and feasible, without increasing postoperative complications compared to standard inpatient surgery.