Predictors Associated with a Prolonged Hospital Stay After Single-Port Extraperitoneal Robotic Radical Prostatectomy: A Comparative Analysis of Outpatient Versus Inpatient Care

Abstract

Purpose: To compare the perioperative characteristics of patients receiving outpatient vs inpatient care and to define predictors of inpatient care after single-port extraperitoneal robotic radical prostatectomy (RRP). Patients and Methods: Data on 120 patients who underwent single-port extraperitoneal RRP were collected and categorized into two groups: Group I (n = 98) included patients who received outpatient care (i.e. discharged on postoperative day 0) and Group II (n = 22) comprised patients with inpatient care. Demographics and perioperative data were recorded and analyzed between the two groups. Multivariable binary logistic regression was used to determine factors associated with inpatient care. Results: Most patients (98/120: 81.7%) were discharged in few hours (median: 4.1 hours) after surgery (outpatient care: Group I [n = 98]), whereas others (Group II [n = 22]) received inpatient care (median hospital stay: 25.4 hours); p < 0.00001. Most patients with inpatient care (13/22, 59.1%) were among the first initial 40 cases, whereas 37 out of last 40 patients received outpatient care (p = 0.005). Operative time was significantly shorter in patients with outpatient prostatectomy (p = 0.015). The amount of narcotics per patient (if administered) was also significantly greater in Group II (p = 0.006). With regression analysis, having medical comorbidities (odds ratio [OR]: 3.41 95% confidence interval [CI]: 2.05-5.64; p = 0.014), a longer operative time (OR: 1.15 95% CI: 1.10-1.28, p = 0.017), as well as a higher dose of administered narcotics after operation (OR: 1.31 95% CI: 1.08-1.61, p = 0.005) were significant predictors of inpatient care after single-port extraperitoneal RRP. Conclusion: A safe transition to outpatient care is feasible in patients undergoing single-port extraperitoneal RRP. In addition to associated medical comorbidities, a longer operative time and the amount of received narcotic after procedure were the most significant predictors of prolong hospital stay after single-port extraperitoneal RRP. These later modifiable predictors can be optimized with improvement of surgical techniques, intraoperative and postoperative pain management protocols through quality improvement initiatives.

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).…”

“…Aminsharifi et al in 2020 found similar barriers of PONV in their cohort of patients who failed SDD, and point to the use of postoperative opioids as a risk factor (OR: 1.31, p¼0.005). 6 Many of these challenges would be mitigated by strict adherence to ERAS protocols, as well as implementing a prehabilitation program, similar to that of Ploussard et al in 2020, 25 for patients prior to SDD RARP.…”

“…Following these initial publications demonstrating the safety of SDD RARP, selection criteria have become less stringent. 4–6…”

Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy

“…Wilson et al previously validated the feasibility of an outpatient protocol for extraperitoneal (EP) SP-RALP [ 9 ]. Another retrospective study conducted at the same institution concluded that increased OR time and post-operative narcotic administration were factors significantly associated with increased likelihood of inpatient care following EP SP-RALP [ 10 ].…”

First Canadian experience with same-day discharge after robot-assisted radical prostatectomy

“…[3][4][5][6][7][8][9][10] Originally, SDD RARP was offered to carefully selected patients, such as those with Grade Group 1 disease, however the addition of pelvic lymph node dissection (PLND) has not been shown to increase rates of complications. 4,5,11,12 Given the success observed internationally, we aimed to implement a SDD RARP protocol at a high-volume Canadian center.…”