ABSTRACT
INTRODUCTION AND OBJECTIVE: In 2016 we began offering optional same-day discharge (SDD) to all robotic prostatectomy (RP) patients with increasing acceptance that accelerated during the COVID pandemic. Our resulting 98% SDD rate for RP after COVID facilitated initiation of an ambulatory surgery center (ASC) robotic urology program without overnight capability and planned SDD in all patients. We assessed our outcomes with planned outpatient RP in all patients in both the hospital and ASC settings. METHOD(S): We reviewed one year of consecutive RPs performed by a single surgeon at either a free-standing ASC or one of three hospitals between October 2021-October 2022. Pelvic lymphadenectomy was performed in all patients. Assignment to ASC versus hospital RP was based primarily on insurance eligibility. ASC policy for robotic or non-robotic procedures alike excluded history of severe cardiac disease, difficult airway, malignant hyperthermia, or BMI >45kg/m2 with no additional limitations applied to robotic surgery. All patients were instructed to expect same-day discharge (SDD) directly from the recovery room regardless of ASC or hospital location with overnight stay only for unexpected complications or side effects of anesthesia. RESULT(S): Among 359 RP cases (162 ASC and 197 hospital), 356 (99%) were successfully discharged the same day as surgery with 3 overnight stays in the hospital group and none in the ASC group. Patients in the ASC group were younger (61.4yrs vs 67.1yrs, p<001) with no statistically-significant difference in BMI (29.2 kg/m2 vs 29.3 kg/ m2, p=0.3), preoperative Gleason Score (p=0.1), operative time (131min vs 134min, p=0.2) or blood loss (87.5cc vs 84.8cc, p=0.71). Excluding the three overnight patients in the hospital group, the mean postoperative recovery room stay among SDD patients was shorter in the ASC group (1.7hrs vs 2.3hrs, p<0.0001). The 90-day readmission rate was 2.5% in both groups (4/162 and 5/197, p=0.93). No readmissions occurred within 24 hours of surgery and only one within the first week. CONCLUSION(S): Same day discharge as a routine following robotic prostatectomy is feasible and safe with readmission rates no higher than series with overnight stays. SDD may enable ASC RP when overnight stay capabilities are not available at an ASC with minimal risk of need for hospital transfer.
ABSTRACT
BACKGROUND: The COVID-19 pandemic impacted local health department clinic availability for routine STI screening. In an effort to improve low CT/GC screening rates observed throughout the Commonwealth, we implemented a limited program to offer athome, self-collection kits to Virginia residents. METHOD(S): We worked with a vendor to procure two options for at-home CT/GC screening: box one included a vaginal swab and box two included a urine collection kit, rectal swab, and pharyngeal swab. We integrated athome CT/GC screening options with the existing at-home HIV screening program. Individuals completing an online survey to determine eligibility for an at-home HIV test were offered the option to also receive a CT/GC test kit. RESULT(S): We distributed 496 CT/GC test kits to Virginia residents. Thirty percent (n=147) of distributed test kits were returned to the laboratory. The positivity rates were highest for rectal CT (5.4%), followed by rectal GC (2.0%) and pharyngeal GC (2.0%). Among participants with a resulted test kit, the majority (42.86%) identified as heterosexual. Forty-two percent reported their last CT/GC test was less than one year ago and 64% reported their last HIV test was less than one year ago. Participants reported that their main motivation for requesting an at-home CT/GC test kit was due to the privacy of screening in their own home (53%), followed by not having time to get screened (14%), and impacts from the COVID- 19 pandemic (13%). CONCLUSION(S): At-home specimen collection presents a novel way to engage individuals in screening. Although the majority report screening within the past year, 20.4% and 10.2% report no screening history for STIs or HIV, respectively. The low rate of returned test kits suggests the need for additional intervention, like reminders or incentives, may be necessary.