Predictors for selection of outpatient single‐port robot‐assisted laparoscopic radical prostatectomy

Abstract

ObjectiveTo evaluate the different perioperative variables that may serve as important clinical predictors when selecting patients for outpatient single‐port robot‐assisted radical prostatectomy (SP‐RARP).Patients and MethodsA retrospective review was performed on the Institutional Review Board‐approved, prospectively maintained database to identify 485 consecutive patients who underwent SP‐RARP between 2018 and 2023. A comparison analysis was performed on patients who were managed as outpatients vs inpatients following their respective SP‐RARP. A separate analysis was performed after excluding patients with pre‐planned admissions to identify the risk factors for unplanned admissions.ResultsAll procedures were successfully completed without any conversion or additional ports. After excluding patients with pre‐planned admissions, outpatient SP‐RARP was successfully achieved in 86.6% with a median (interquartile range) length of stay of 4.6 (3.8–6.1) hours. Our multivariate regression analysis identified cardiac comorbidity and preoperative International Prostate Symptom Score (IPSS) as predictors of outpatient SP‐RARP. In addition, the absence of cardiac comorbidity, previous abdominal surgery, and lower postoperative pain score were protective against the risk of unplanned admission. Furthermore, both inpatient and outpatient encounters had comparable 90‐day rates of postoperative complication (P = 0.136) and hospital re‐admission (P = 0.942).ConclusionOutpatient management models could be successfully achieved in most patients who underwent SP‐RARP (86.6%) while maintaining similarly low perioperative morbidity profile. Nevertheless, appropriate patient selection based on the baseline clinicodemographic characteristics remains essential to ensure the safety and ongoing success of outpatient SP‐RARP.