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

Abstract

(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.

A prehabilitation programme implemented before robot‐assisted radical prostatectomy improves peri‐operative outcomes and continence recovery

“…In our study, although without reaching statistical significance, we observed an improvement in all peri‐operative outcomes in favour of PreHab+ vs PreHab− in the context of ERAS for all patients. The further development of programmes such as ERAS and PreHab could also translate into the wider implementation of same‐day discharge after RARP and could generate cost reductions at the hospital and healthcare system levels [14,24–26]. Another interesting point is that the mean length of stay in the present study was significantly shorter than the national statistics.…”

Better clinical benefits and potential cost saving of an enhanced recovery pathways for laparoscopic adrenalectomy

“…Moreover, prehabilitation pathway along with ERPs and robotic surgery has also been suggested to work synergistically in improving outcomes after inpatient robotassisted radical prostatectomy (RARP), and to gain a wider acceptance of same day discharge (SDD), which is supposed to have a positive impact on pain control, general activity, and reduced overall costs. A multi-surgeon comparative study confirms the safety of routine SDD and RARP in terms of perioperative outcomes (32), trends favoring ERPs combined with prehabilitation, SSD and robotic surgery need to be confirmed, these improvements may promote high quality of life together for patients. Another two studies provided available data to support ERPs for patients undergoing radical cystectomy leading to a shorter LOS without increasing readmission or complication rates (33,34), suggesting more solid evidence of assessing the clinical and economic impact of ERPs.…”

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

“…There were 8 studies that reported on complication rates among 822 SDD RARPs (range 0%–24%) and 1,881 IP RARPs (2%–28.2%), 4–6,10,12,18–20 and meta-analysis favored lower overall complication rate in the SDD group (RR: 0.7, 95% CI 0.5,0.9, p=0.02; see supplementary Figure, https://www.urologypracticejournal.com). However, there was no difference in risk of ≥grade 3 CD complications (RR: 0.4, 95% CI 0.2, 1.1, p=0.07), 90-day readmission rates (RR: 0.6, 95% CI 0.3, 1.1, p=0.10) or unscheduled emergency department visits (RR: 1.0, 95% CI 0.3, 3.1, p=0.97).…”