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

Rahota, Razvan-George; Salin, Ambroise; Gautier, Jean-Romain; Alméras, Christophe; Loison, Guillaume; Tollon, Christophe; Beauval, Jean Baptiste; Ploussard, Guillaume

doi:10.3390/jcm10040661

Cited by 17 publications

(26 citation statements)

References 21 publications

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“…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.…”

Section: Discussionmentioning

confidence: 75%

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

Rahota¹,

Salin²,

Gautier³

et al. 2021

BJU International

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To assess the impact of a routine, on-site, 1-day prehabilitation (PreHab) programme on peri-operative and continence recovery after robot-assisted radical prostatectomy (RARP). Materials and MethodsAll 303 consecutive RARPs performed between March 2018 and February 2020 since the routine implementation of PreHab were included in our study. PreHab was carried out according to the availability of the 1-day programme before the planned date of surgery (two sessions per month including four patients per session). The PreHab programme was implemented in 165 patients (54.5%). The primary endpoint was continence recovery, strictly defined as no safety pad use at 1 and 6 months. Secondary endpoints were peri-operative variables (blood loss, operating time, length of stay, transfusion, complications, and readmission rates). Comparisons were made according to whether the PreHab pathway was applied or not (PreHab+ vs PreHabÀ) in univariable and multivariable models. ResultsThe PreHab pathway was implemented for a stable proportion of patients over time (54.5%). The two cohorts were comparable in terms of preoperative and pathological features (P > 0.05). Length of stay was significantly shorter in the PreHab+ group (1.3 vs 1.9 days; P = 0.001). There was a trend towards fewer complications in the PreHab+ group (P = 0.061). Use of the PreHab pathway was independently correlated with higher continence rates at 1 month (37% vs 60%; P < 0.001) and 6 months (67.4% vs 87.3%; P < 0.001), even after controlling for age, body mass index, prostate volume, type of apical reconstruction, nerve-sparing surgery and lymph node dissection. The main limitation of the study was the absence of randomization. ConclusionsOur experience demonstrates that the PreHab programme is the major predictor of improved peri-operative outcomes and continence recovery after RARP, with sustainable benefits 6 months after surgery.

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Section: Discussionmentioning

confidence: 75%

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

Rahota¹,

Salin²,

Gautier³

et al. 2021

BJU International

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“…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.…”

Section: Discussionmentioning

confidence: 89%

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

Yan¹,

Cheng²,

Chen³

et al. 2022

Gland Surg

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Background: Enhanced recovery pathways (ERPs) have been demonstrated to be clinically and economically effective for colorectal surgery. However, data are lacking to support the cost-effectiveness of ERPs for laparoscopic adrenalectomy, as well as potential economic loss. This study aims to determine the cost-effectiveness of ERPs vs. conventional care (CC) for patients undergoing laparoscopic adrenalectomy.Methods: A single centered retrospective case-control study was performed. Patients undergoing laparoscopic adrenalectomy from January 2018 to June 2021 were enrolled. One inpatient ward used ERPs, whereas the other did not. Case control was used for matching (53 patients for each group). Postoperative outcomes were recorded up to 30 days after surgery. ERPs-specific costs were integrated into the model.Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration, which were reported in Renminbi. A bootstrap independent t test was used for comparison. Results:The two groups were matched in terms of demographics and surgical details. Hospital stay was significantly shorter in the ERPs group (2.54 days, P<0.001). The rate of complications was lower in the ERPs group (1 vs. 7 patients, P=0.031), there was no severe complications or morbidity. ERPs-specific costs were ¥656 per patient. The self-payment cost difference per patient between the two groups was ¥3,154.52 in favor of the ERPs group, but this was not statistically significant (P=0.113). The mean direct saving per patient in the ERPs group was ¥8,326.00, the total costs saving including indirect and potential overhead per patient was ¥18,247.60.Conclusions: Enhanced recovery is cost-effective compared with conventional perioperative management for laparoscopic adrenalectomy. Savings were noted in disposable materials, medicine and medical services, radiology and laboratory costs, with no increase in morbidity or duration.

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“…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).…”

Section: Resultsmentioning

confidence: 99%

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

Millan

Jones

et al. 2022

Urology Practice

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Introduction: Same-day discharge (SDD) following robot-assisted radical prostatectomy (RARP) is emerging as the standard of care. We conducted a systematic review and meta-analysis to evaluate the differences in perioperative characteristics, complication/readmissions rates and satisfaction/cost data between inpatient (IP) RARP and SDD RARP.Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was prospectively registered with PROSPERO (CRD42021258848). A comprehensive search of PubMedÒ, EmbaseÒ, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and conference abstract publications was performed. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias.Results: A total of 14 studies were included with a pooled population of 3,795 patients, including 2,348 (61.9%) IP RARPs and 1,447 (38.1%) SDD RARPs. SDD pathways varied, though many commonalities were present in patient selection, perioperative recommendations and postoperative management. When compared to IP RARP, SDD RARP had no differences in !grade 3 ClavieneDindo complications (RR: 0.4, 95% CI 0.2, 1.1, p¼0.07), 90-day readmission rates (RR: 0.6, 95% CI 0.3, 1.1, p¼0.10) or unscheduled emergency department visits (RR: 1.0, 95% CI 0.3, 3.1, p¼0.97). Cost savings per patient ranged between $367 and $2,109, and overall satisfaction was high at 87.5%e100%.Conclusions: SDD following RARP is both feasible and safe, while potentially offering health care cost savings with high patient satisfaction rates. Data from this study will inform the uptake and development of future SDD pathways in contemporary urological care such that it may be offered to a broader patient population.

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

Cited by 17 publications

References 21 publications

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

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

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

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

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