Same-day discharge surgery for robot-assisted radical prostatectomy in the era of ERAS and prehabilitation pathways: a contemporary, comparative, feasibility study

Ploussard, Guillaume; Alméras, Christophe; Beauval, Jean-Baptiste; Gautier, Jean-Romain; Loison, Guillaume; Salin, Ambroise; Tollon, Christophe

doi:10.1007/s00345-020-03119-w

Cited by 42 publications

(67 citation statements)

References 23 publications

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“…Abaza et al, in a U.S. healthcare system suggested a not negligible reduction in charges per patient [14]. We also denoted same benefits (10% reduction) in the French healthcare system [13].…”

Section: Discussionmentioning

confidence: 76%

“…No increase in complications, readmissions, or unplanned visits was associated with SDD. Ploussard et al confirmed the comparable short-term peri-operative outcomes between the two types of hospitalization [13]. Khalil et al analyzed data from the National Surgical Quality Improvement Program of the American College of Surgeons by comparing SDD patients (n = 258) and overnight stay patients (n = 1290) [16].…”

Section: Discussionmentioning

confidence: 95%

“…Several series have demonstrated that SDD was feasible in various countries, in Europe and North America [10][11][12][13]. However, most of them were single-center series without multi-institutional validation or comparisons between inpatient and outpatient surgeries.…”

Section: Introductionmentioning

confidence: 99%

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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: 76%

Section: Discussionmentioning

confidence: 95%

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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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“…Despite the noted study limitations, these results still indicate a role of selective use of surgical drain tubes based on factors including specific patient characteristics, concerns with the anastomosis or issues with hemostasis rather than adopting a blanket rule for all patients where the default action is to place a drain tube. The concept of omitting a drain tube would also be in‐line with enhanced recovery after surgery (ERAS) protocols and the growing notion of same‐day discharge RARP which is getting explored more and more in some parts of the world 22,23 …”

Section: Discussionmentioning

confidence: 99%

Review of the use of prophylactic drain tubes post‐robotic radical prostatectomy: Dogma or decent practice?

et al. 2020

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Objective To assess the necessity of routine prophylactic drain tube use following robot‐assisted radical prostatectomy (RARP). Method We performed a literature review using the Medline, Scopus, and Web of Science databases with no restriction of language from January 1900 to January 2020. The following terms we used in the literature search: prostatectomy, radical prostatectomy, robot assisted, drainage, and drain tube. Results We identified six studies that examined the use of routine prophylactic drain tubes following RARP. One of these studies was a randomized study that included 189 patients, with 97 in the pelvic drain (PD) arm and 92 in the no pelvic drain (ND) arm. This non‐inferiority showed an early (90‐day) complication rate of 17.4% in the ND arm versus 26.8% in the PD arm (P < .001). Another non‐inferiority randomized control trial (RCT) showed a complication rate of 28.9% in the PD group versus 20.4% in the ND group (P = .254). Similarly, the other studies found no benefit of routine use of prophylactic drain tube after RARP. Conclusion Drain tubes play a role during robotic‐assisted radical prostatectomy, however, following a review of the current available literature, they can be safely omitted and we suggest that clinicians may be selective in their use.

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“…Dies gilt z. B. für die Lippen-und Gaumenoperation [25], die Thyreoidektomie [26], die Fuß-und Sprunggelenkschirurgie [27], die radikale Prostatektomie [28] und die Parotidektomie [29]. Ähnlich wie in der phlebochirurgischen Literatur wird auch in diesen Arbeiten auf die Möglichkeit einer ambulanten Behandlung hingewiesen mit der entscheidenden Einschränkung, dass eine geeignete Auswahl der Patienten stattfinden müsse.…”

Section: Ergebnisseunclassified

Offene Varizenchirurgie – wann ambulant, wann stationär?

Frings¹,

Rass²,

Bruning³

et al. 2020

Phlebologie

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Zusammenfassung Hintergrund Die offene Varizenchirurgie kann sowohl in einem ambulanten als auch in einem stationären Setting durchgeführt werden. Aktuelle Leitlinien zur Therapie der Varikose nehmen zu der Frage, welche Patienten ambulant und welche stationäre zu operieren sind, nicht Stellung. Fragestellung Erarbeitung von Kriterienkatalogen zur Frage einer ambulanten oder stationären Varizenoperation. Material und Methode PubMed-Recherche zur Fragestellung und basierend auf den Literaturdaten Erarbeitung eines Delphi-Konsensus der Autoren. Ergebnisse Zur Frage, ob eine Varizenchirurgie ambulant oder stationär durchgeführt werden kann, existieren lediglich 2 monozentrische retrospektive Analysen sowie eine Registerstudie. In diesen Studien werden ambulante Operationen im Wesentlichen bei Patienten mit Normalgewicht und ASA-Stadium 1 durchgeführt. Gut geeignete Lokalbefunde für eine ambulante Operation sind Primäreingriffe und ein geringeres C-Stadium der CEAP-Klassifikation. Für eine stationäre Varizenoperation sprechen ausgedehnte Befunde, bei denen mehr als eine Crosse saniert werden muss, Rezidiveingriffe in der Leiste oder der Kniekehle, vorangegangene thromboembolische Ereignisse, eine erhöhte Blutungsneigung aufgrund monströser Varizen oder einer Antikoagulation, Hautkomplikationen wie ein Ulcus cruris oder eine schwere Stauungsdermatitis bzw. Dermatosklerose sowie ein BMI über 30 bei Crossektomie. Schlussfolgerungen Basierend auf Literaturdaten und Expertenmeinungen konnten Kriterienkataloge für eine ambulante versus stationäre offene Varizenchirurgie erarbeitet werden.

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Same-day discharge surgery for robot-assisted radical prostatectomy in the era of ERAS and prehabilitation pathways: a contemporary, comparative, feasibility study

Cited by 42 publications

References 23 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

Review of the use of prophylactic drain tubes post‐robotic radical prostatectomy: Dogma or decent practice?

Offene Varizenchirurgie – wann ambulant, wann stationär?

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