Assessment of routine same-day discharge surgery for robot-assisted radical prostatectomy

• Published in: World journal of urology Vol. 41; no. 10; pp. 2679 - 2684
• Main Authors: Broe, Mark, Carbin Joseph, Danny Darlington, Casson, Helen, Innes, Maria, Adamou, Constantinos, Fragkoulis, Gerasimos, Moschonas, Dimitrios, Kusuma, Venkata Ramana Murthy, Hicks, James, Patil, Krishna, Perry, Matthew James Alexander, Abou Chedid, Wissam
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2023; Springer Nature B.V
• Subjects: Body mass index; Constipation; COVID-19; Humans; Male; Medicine; Medicine & Public Health; Nephrology; Oncology; Original Article; Pain; Patient Discharge; Patient satisfaction; Patients; Prostatectomy; Prostatectomy - methods; Robotic surgery; Robotic Surgical Procedures - methods; Robotics; Surgery; Treatment Outcome; Urological surgery; Urology; Robotic surgery; Robotic-assisted radical prostatectomy; RARP; Same-day discharge; Day-case; Day of surgery discharge
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-023-04566-x

Introduction It is important for robotic surgery to be cost-effective, especially by reducing the length of stay (LOS). Therefore, we developed a protocol for day-case robot-assisted radical prostatectomy (RARP). This study aimed to validate this as a safe practice of care and to assess the potential benefits to the hospital and patient. Methods In this single-centre study, all patients booked for RARP between April 2022 and October 2022 were screened for suitability for day case. All tumour types were included. Exclusion criteria were a history of complex abdominal surgeries, salvage prostatectomy, body mass index (BMI) > 35 and patient living alone or > 150 km away from the hospital. All day-case RARPs were performed as a morning case with a protocol for review throughout the day with evening discharge if mobilising independently and eating/drinking well. The primary outcome of the study was success rate of discharge home on day of surgery (DOS) with secondary outcomes of readmissions and complications. A patient questionnaire was completed at home including both visual analogue scale (VAS) for pain and satisfaction rating. Results Forty-five patients underwent day-case RARP over a 6-month period with minimum of 30 days of follow-up. 41/45 (91%) had successful DOS discharge home. The four admissions overnight were due to dizziness, low oxygen saturation, intraoperative complications and a diagnosis of COVID-19. There were no readmissions and no 30-day complications. The most common issues at home were catheter discomfort and constipation with low mean VAS pain score and low nausea reported. The overall patient satisfaction rating was very high at 4.8/5, and 97% said they would recommend to a family member. The cost saving for the hospital was 400 pounds per patient. Conclusion Day-case procedure is a viable, safe and efficient pathway for appropriately selected and counselled patients undergoing RARP.