Same Day Discharge for Robotic-assisted Radical Prostatectomy: Recommendations from a Referral Center

ABSTRACT

Introduction & Objective: Due to the COVID-19 global pandemic, in July 2020 we developed a same day discharge (SDD) protocol for robotic assisted laparoscopic prostatectomy (RALP) that balanced safety concerns with benefits of early discharge. In this study we present our experience and protocol. Methods: We performed a prospective analysis of patients undergoing RALP who were selected for SDD in a high-volume prostate cancer referral center. The criteria for discharge included uncomplicated surgery, stable postoperative hemoglobin, ambulation, tolerance of clear liquids without nausea or vomiting, pain control with oral medication, and patient/family comfort with SDD. We excluded patients older than 70 years, having concomitant general surgery operations, significant comorbidities (e.g. cardiopulmonary disease), and challenging procedures (e.g. salvage procedure, large prostates). We analyzed patient demographics, clinicopathologic factors, and operative outcomes and evaluated rates of SDD and factors associated with SDD failure (SDF). Results: From July 13, 2020 to January 1, 2021, 101 patients undergoing RALP were selected for SDD. Eighty patients (79%) met criteria , 73 (72%) were successful SDD, and 28 (28%) were SDF. All the SDF were discharged on postoperative day 1. Preoperative demographics were similar between the two groups with a median age of 63 (57-67) years and median BMI of 27 (25-30) kg/m2. Intraoperative characteristics were not statistically different with a median operative time of 92 (81-107) vs 103 (91-111) minutes for SDD and SDF respectively (P = 0.51). The readmission in the SDD group was due to dizziness from hematoma and ileus from urine leak in the SDF cohort (P = 0.69). Of the 28 SDF patients, the most common reasons for staying were anesthesia-related factors of nausea (35%) and drowsiness (7%), followed by patient/caregiver preference (25%), pain (14%), labile blood pressure (7%), arrhythmia (7%), and dizziness (7%). Conclusions: SDD for patients undergoing RALP can be safely incorporated into a clinical care pathway without increasing readmission rates. Coordinated care with anesthesia and nursing teams is an integral part of developing a SDD program, as is preoperative counseling to manage expectations. Future aims will be to investigate anesthesia factors leading to nausea and to expand selection to more patients.