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

Kotamarti, Srinath; Williams, Thomas R.; Silver, Michael; Silver, David; Schulman, Ariel

doi:10.1007/s11701-020-01115-1

Cited by 8 publications

(10 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent research in the field suggests that a single night's stay or same-day discharge might be possible for selected patients regarding safety. 19,20 Compared to our study, RALP did show a lower transfusion rate and minimized the immediate complications, while our data did not show an extremely shortened hospital stay due to various reasons, such as institute policy and the patients' request. Implementing enhanced recovery after surgery (ERAS) protocols might be one solution that could contribute toward this outcome.…”

Section: Original Article Smjcontrasting

confidence: 77%

Paradigm Shift from Open Surgery to Minimally Invasive Surgery in Three Approaches for Radical Prostatectomy: Comparing Outcomes and Learning Curves

Srinualnad

Hansomwong²,

Aussavavirojekul³

et al. 2022

Siriraj Med J

View full text Add to dashboard Cite

Objective: Radical prostatectomy (RP) can be performed by several approaches, such as open retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), and robotic-assisted laparoscopic prostatectomy (RALP). This study investigated and shared the differences in the surgical techniques, learning curves, and outcomes of each approach of RP.Materials and Methods: The data of patients who received RP given by one of the authors between January 2002 to June 2016 were retrospectively reviewed. We compared perioperative and postoperative outcomes among approaches, searched for predictors of a positive surgical margin (PSM), and assess the learning curves of the two minimally invasive approaches.Results: 527 patients underwent RP during January 2002 to June 2016 including 42 RRP, 198 LRP, and 327 RALP. RALP had the highest negative surgical margin (68.8%) and lowest multifocal positive surgical margin (10.7%). PSM predictors were the Gleason score and pathological T staging. The learning curve showed that RALP needed one-hundred-cases experience to achieve the lowest PSM rate and 200 cases to master bleeding control. In the first 100 cases in each group, the PSM rate in LRP was lower than in RALP.Conclusion: Minimally invasive approach in radical prostatectomy showed significant improvements over RRP, especially the RALP approach. RALP would take a surgeon 100 and 200 cases to reach the plateau on the learning curve for achieving the desired oncologic and perioperative outcome efficiencies, respectively. However, LRP and RRP are still feasible in a service setting and for training purposes.

show abstract

Section: Original Article Smjcontrasting

confidence: 77%

Paradigm Shift from Open Surgery to Minimally Invasive Surgery in Three Approaches for Radical Prostatectomy: Comparing Outcomes and Learning Curves

Srinualnad

Hansomwong²,

Aussavavirojekul³

et al. 2022

Siriraj Med J

View full text Add to dashboard Cite

show abstract

“…Finally, during a global pandemic (COVID-19), healthcare systems are highly strained, and access to care can be lowered; hence, overnight stays or same-day discharge for RARP (and other MIRP) are considered to be safe. 40,50,54 Other systematic reviews have addressed the effectiveness of interventions at reducing UPV in other disease sites and procedures. [88][89][90] A descriptive systematic review of 43 studies, reporting 30-day UPV reduction, by Hansen et al, ultimately found that no single intervention applied in isolation was correlated with a significant drop in 30-day UPV risk (similar to our findings).…”

Section: Cuaj -Original Researchmentioning

confidence: 99%

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

Mukkala¹,

Song²,

Lee³

et al. 2021

CUAJ

View full text Add to dashboard Cite

Introduction: Unplanned visits (UPV) — re-admissions and emergency room (ER) visits — are markers of healthcare system quality. Radical prostatectomy (RP) is a commonly performed cancer procedure, where variation in UPV represents a gap in care for prostate cancer patients. Here, we systematically synthesize the rates, reasons, predictors, and interventions for UPV after RP, to inform evidence-based quality improvement (QI) initiatives. Methods: A systematic review was performed for studies from 2000–2020 using keywords: “re-admission,” “emergency room/department,” “unplanned visit,” and “prostatectomy.” Studies that focused on UPV following RP and that reported rates, reasons, predictors, or interventions, were included. Data was extracted via a standardized form. Meta-analysis was completed. Results: Sixty studies, with 406 107 RP patients, were eligible; 16 028 UPV events (~5%) were analyzed from 317 050 RP patients. UPV rates after RP varied between studies (ER visit range 6–24%; re-admissions range 0–56%). The 30-day and 90-day ER visit rates were 12% and 14%, respectively; the 30-day and 90-day re-admission rates were 4% and 9%, respectively. A total of 55% of all re-admissions after RP are directly due to postoperative genitourinary (GU)-related complications such as strictures, obstructions, fistula, bladder-related, incontinence, urine leak, renal problems, and other unspecified urinary complications. The next most common re-admission reasons were anastomosis-related, infection-related, cardiovascular/pulmonary events, and wound-related issues. Thirty-four percent of all ER visits after RP are directly due to urine-related issues such as retention, urinoma, obstruction, leak, and catheter problems. The next most common ER visit reasons were abdominal/gastrointestinal issues, infection-related, venous thromboembolic events, and wound-related issues. Predictors for increased re-admission included: open RP, lymph node dissection, Charlson comorbidity index≥2, low surgeon/hospital case volume, and socioeconomic determinants of health. Of the 10 interventions evaluated, a 3.4% average reduction in UPV rate was observed, highlighting an approximate two-fold decrease. Meta-analysis demonstrated a significant benefit of interventions over controls with odds ratio 0.62 (95% confidence interval 0.46–0.84). Interventions that used multidisciplinary, nurse-centered, programs, with patient self-care/empowerment were more beneficial than algorithmic patient care pathways and preoperative patient education. Conclusions: Twenty years of international, retrospective, experience suggests UPV after RP are often related to GU complications, infection- or wound-related factors. QI interventions to reduce UPV should target these factors. While many re-admissions after RP appear to be unavoidable, ER visits have more opportunity for volume reduction by QI. The interventions evaluated herein have potential to reduce UPV after RP.

show abstract

“…Two studies with the same primary author will be included as the studies differ in geographic locations, 9,10 and only the comparative study will be included in the meta-analyses. 10 Two studies utilizing the American College of SurgeonsÒ National Surgical Quality Improvement ProgramÒ database will be included, 11,12 though only the data by Khalil et al from 2020 will be used for meta-analysis due to a larger sample size.…”

Section: Study Eligibilitymentioning

confidence: 99%

“…2e6,9e12,18e22 Study Characteristics and Quality There were 14 articles included for analysis, including 8 prospective cohort studies, 2,5,6,9,10,18,19,22 and 6 retrospective cohort studies. 3,4,11,12,20,21…”

Section: Study Identificationmentioning

confidence: 99%

Successful Same-Day Discharge for Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis

Millan

Jones

et al. 2022

Urology Practice

View full text Add to dashboard Cite

Introduction: Same-day discharge (SDD) following robot-assisted radical prostatectomy (RARP) is emerging as the standard of care. We conducted a systematic review and meta-analysis to evaluate the differences in perioperative characteristics, complication/readmissions rates and satisfaction/cost data between inpatient (IP) RARP and SDD RARP.Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was prospectively registered with PROSPERO (CRD42021258848). A comprehensive search of PubMedÒ, EmbaseÒ, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and conference abstract publications was performed. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias.Results: A total of 14 studies were included with a pooled population of 3,795 patients, including 2,348 (61.9%) IP RARPs and 1,447 (38.1%) SDD RARPs. SDD pathways varied, though many commonalities were present in patient selection, perioperative recommendations and postoperative management. When compared to IP RARP, SDD RARP had no differences in !grade 3 ClavieneDindo complications (RR: 0.4, 95% CI 0.2, 1.1, p¼0.07), 90-day readmission rates (RR: 0.6, 95% CI 0.3, 1.1, p¼0.10) or unscheduled emergency department visits (RR: 1.0, 95% CI 0.3, 3.1, p¼0.97). Cost savings per patient ranged between $367 and $2,109, and overall satisfaction was high at 87.5%e100%.Conclusions: SDD following RARP is both feasible and safe, while potentially offering health care cost savings with high patient satisfaction rates. Data from this study will inform the uptake and development of future SDD pathways in contemporary urological care such that it may be offered to a broader patient population.

show abstract

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

Cited by 8 publications

References 13 publications

Paradigm Shift from Open Surgery to Minimally Invasive Surgery in Three Approaches for Radical Prostatectomy: Comparing Outcomes and Learning Curves

Paradigm Shift from Open Surgery to Minimally Invasive Surgery in Three Approaches for Radical Prostatectomy: Comparing Outcomes and Learning Curves

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

Successful Same-Day Discharge for Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About