Safety and feasibility of same-day discharge laparoscopic radical prostatectomy: a systematic review

Abstract

Purpose Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging patients within 24 h, reducing costs and length of stay, and facilitating return to active life. We perform a systematic review of literature to evaluate the feasibility of SDD RP. Methods A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Embase. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. Results Based on the literature search of 509 articles, 12 (1378 patients) met the inclusion criteria (mean age: 63 years). All studies were unicentric except one. The mean SDD surgeries experience per centre was 66 cases .The means operative time and blood loss were 154 min and 126.5 ml, respectively. Mean SDD failure was 7.4%. Concomitant lymph node dissection was performed in 56.2%. The overall complication rate was 10.2% of cases; with a majority of Clavien grade I or II. Mean readmission rate after discharge was 5%. SDD generated cost reductions compared to inpatient surgery with variable differences according to the considered healthcare system. Conclusions Day-case RP is a safe and feasible strategy in selected cases with multicentre proofs of concept. Its widespread use in routine practice needs further research due to biases in patient selection. Implementation of peri-operative pathways such as ERAS and prehabilitation improves patient adherence to SDD.

Prostatectomie radicale ambulatoire versus hospitalisation conventionnelle : comparaison des suites opératoires et de la satisfaction du patient

“…The recent systematic review by Saouli et al (11) about ambulatory prostatectomy corroborates our results with similar complication rates, especially for high grade complication (0 to 11.7%), and similar same day discharge failure and readmission rates. Our study is similar to that by Rahota et al (12) where the same comparisons were made, with results consistent with our own (19% complications and 2.4% high grade complications for the outpatient group, no significant difference with inpatient group).…”

“…Since 2016, an increasing number of publications suggests that outpatient RARP is feasible, safe and effective (8)(9)(10)(11)(12)(13)(14)(15).…”

“…Depuis 2016, une littérature florissante tend à montrer que l'ambulatoire dans la PRRA est réalisable en sécurité, avec de bons résultats fonctionnels, des taux de complications non majorés, et une qualité de vie maintenue (8)(9)(10)(11)(12)(13)(14)(15).…”

Ambulatory anesthesia and discharge: an update around guidelines and trends

“…There are a series of systematic reviews and meta-analyses presenting aggregated information around safety and feasibility for SDD following joint replacement [33 ▪▪ ,34 ▪▪ ], hysterectomy [35 ▪▪ ], radical prostatectomies [36 ▪▪ ] and thyroidectomy [37 ▪▪ ].…”

“…The SDD patients had shorter operation time and lower overall complication rate; no further differences were found. Saouli et al [36 ▪▪ ] published in June 2022 a meta-analysis around SDD following radical minimal invasive prostatectomies. The analysis included 12 studies, 1378 patients, and a mean age of 63 years.…”