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

Abstract

Introduction: We aimed to evaluate the feasibility and safety of implementing a same-day discharge (SDD) protocol for robot-assisted radical prostatectomy (RARP) and pelvic lymph node dissection. Methods: We performed a prospective cohort study including all consecutive eligible patients undergoing RARP in 2021 following initiation of SDD RARP protocol in April. Baseline characteristics were compared using t-tests, Mann-Whitney U tests, and odds ratios (OR) calculated using multiple logistic regression to assess for predictors of SDD success. Results: A total of 117 patients underwent RARP in 2021 following initiation of the SDD protocol. Fifty-seven patients were initiated on the SDD pathway, and 60 patients underwent surgery as an inpatient (IP-RARP). Of those on the SDD pathway (SDD-RARP), 33 (58%) were successfully discharged the same day of surgery, while 24 (42%) failed SDD. Baseline demographics were well-balanced between cohorts. Case order, increased patient age, and distance travelled to the hospital were factors associated with selection of patients for the IP-RARP protocol. In total, 12 SDD and 12 IP patients presented to the emergency department (p=1.0), and none within 24 hours of discharge. There were no hospital admissions in the SDD cohort, with four readmissions in the IP cohort (p=0.1). Multiple logistic regression revealed that case order (second case) was the only predictive factor for SDD success (OR 4.08, 95% confidence interval [CI] 1.59–11.62, p=0.005). Conclusions: Implementation of an SDD pathway following RARP is feasible, with no increase in rates of complications, unscheduled visits, or readmissions.