(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Eric Wendel discussing same day discharge in robotic radical prostatectomy as part of a perioperative pathway. Same day discharge after robotic assisted radical prostatectomy has been documented with relatively low complication rate [1, 2]. As part of a perioperative pathway, and in part due to the COVID-19 pandemic, Dr. Wendel and colleagues have initiated offering same day discharge for patients. At the 2022 SESAUA annual meeting, Dr. Wendel presented results evaluating their institution’s National Surgical Quality Improvement Program (NSQIP) readmissions and complication rates between same day discharge patients and standard of care.
NSQIP data captured 196 patients who underwent robotic radical prostatectomy from January 2019 to June 2021 at one institution among four surgeons. Pelvic lymph node dissection was performed in 94.6% of the standard of care group vs. 96.5% in the same day discharge. 29 of these patients were same day discharges (14.8%), and 166 were the standard of care with 160 being discharged on post-op day 1 and six patients that stayed more than one night. The primary outcome was unplanned readmissions between the two groups, and secondary outcome was Clavien-Dindo grade III or higher complications.
With a minimum of 30 days of follow-up, the mean age and BMI of the same day discharge versus standard of care groups were 60 versus 63 years (p = 0.018) and 29.2 versus 29.7 kg/m2 (p = 0.62), respectively. The mean OR times were 169 minutes for the same day discharge patients and 204 minutes for the standard of care patients (p = 0.0001). Unplanned readmissions between the same day discharge and the standard of care were 1/29 (3.4%) versus 9/166 (5.4%) (p = 0.66). Overall complications Clavien-Dindo grade III or higher requiring procedural intervention were 1/29 (3.4%) in same day discharge and 6/167 (3.5%) in the standard of care patients (p = 0.96):
There were no postoperative deaths, cardiac arrests, CVA, or DVT/PE reported in either group.
Dr. Wendel concluded his presentation assessing same day discharge in robotic radical prostatectomy as part of a perioperative pathway by noting that patients undergoing robotic radical prostatectomy in this single center setting had similar rates of unplanned readmissions and overall major complications when discharged the day of surgery compared to standard of care.
Presented by: Eric Wendel, MD, Department of Urology, Ochsner Medical Center, New Orleans, LA
Co-Authors: John Williams, MD, Michael Maddox, MD, Stephen Bardot, MD
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 86th Annual Meeting of the Southeastern Section of the American Urological Association, San Juan, PR, Mar 16 – 19, 2022
References:
- Wolboldt M, Saltzman B, Tenbrink P, et al. Same-day discharge for patients undergoing robot-assisted laparoscopic radical prostatectomy is safe and feasible: Results of a pilot study. J Endourol. 2016 Dec;30(12):1296-1300.
- Ploussard G, Grabia A, Barret E, et al. Same-day-discharge robot-assisted radical prostatectomy: An annual countrywide analysis. Eur Urol Open Sci. 2021 Dec 23;36:23-25.