Presentation Authors: Mohamed H. Kamel, Mahmoud I. Khalil*, Naleen Raj Bhandari, Nalin Payakachat, Little Rock, AR, Omer A. Raheem, New Orleans, LA, Rodney Davis, Little Rock, AR
Introduction: The use of the da VinciÂ® Robot system is currently the standard in performing radical prostatectomy in prostate cancer patients. The urologists&[prime] experience in performing robotic radical prostatectomy (RRP) has grown significantly with lower complications and shorter operating times in recent years. We investigated the early postoperative complications in patients who underwent RRP and were discharged on the same day of surgery and compared them to a patient group who stayed in hospital longer than 1 day following their RRP.
Methods: The National Surgical Quality Improvement Program database was queried to identify patients who received RRP with same day discharge (OPG) and those who stayed >1 day in the hospital (IPG). Each OPG patient was matched to 3 IPG patients using a propensity score, which was the probability having the same day discharge based on preoperative characteristics (demographics, comorbidities, ASA Class, indicator for metastatic cancer, and data year (â‰¤2011 or >2011) and operating time (OPTIME). Early (â‰¤30 days) postoperative mortality, complications, and readmission rates were compared across both groups. Relative risk (RR) and 95% CI estimates were calculated to determine the risk of early postoperative mortality and complications in OPG vs. IPG adjusted for 1:3 matched design.
Results: A total of OPG 315 patients were identified and matched to 945 IPG patients. All the preoperative characteristics and OPTIME were well balanced in both groups after matching with no significant differences. The proportions of early mortality (0.3% vs. 0.1%; RR: 3, 95%CI: 0.19-48.0) and overall complications (5.1% vs. 6.3%, RR: 0.80, 95%CI: 0.46-1.38) was low and with no statistically significant differences in OPG vs. IPG patients. Additionally, the RRs for any of the reported specific complications (Table 1) were not significantly different across both groups.
Conclusions: Our results demonstrate that the rate of early postoperative morbidity and mortality in RRP patients being discharged on the same day is low and not different compared to those who stayed >1 day in hospital. Same day discharge may be considered in select group of RRP patients and such decision should be tailored on individual patient basis.