Presentation Authors: Robert Gerhard, Oscar Martinez, Ronney Abaza*, Dublin, OH
Introduction: The average length of stay following robotic-assisted radical prostatectomy (RARP) is 24-48hrs and potentially longer on average in community settings. If safe, same day discharge (SDD) following RARP could allow considerable cost savings. The largest previous reports of SDD after RARP include less than 50 highly-selected patients. We report our experience routinely offering SDD after RARP in a community setting and evaluate the safety and cost implications.
Methods: Beginning September 2016, we adjusted our RARP clinical pathway to allow SDD. This included using ultra-low pneumoperitoneum at 6mmHg, immediate ambulation, immediate diet, and scheduled non-narcotic analgesia with optional oral but no intravenous narcotics. Patients were given the option for SDD without it being mandated. After allowing a period of three months to solidify the protocol, we evaluated our prospective database for the next 500 consecutive patients to determine the success rate and safety of SDD.
Results: Of 500 consecutive RARPs performed in 18 months, 246 patients (49.2%) were discharged the day of surgery with all of the remaining 254 discharged the next day for a mean length of stay of 0.51 days. Characteristics included mean age 62yrs (range, 42-81yrs) and BMI 29.7kg/m2 (range, 20-53kg/m2). All patients underwent lymphadenectomy with yield of 8.1 nodes (range, 2-24) with OR time of 161min and blood loss of 135mL with no transfusions. Thirty-four patients (6.8%) overall had a Clavien-Dindo grade I-III complication within 90 days of surgery with no grade IV-V complications, of which only 5 required a visit to the emergency department (1%) and only 8 required readmission (1.6%). Among patients discharged on the day of surgery, only one was readmitted (for deep vein thrombosis), and only one presented to the emergency department (for occluded catheter). The estimated charge for overnight postoperative admission at our institution is $2,109, such that the approximate reduction in charges was $518,814 over 18 months ($345,876/yr) with no increase in costs from emergency room visits or readmissions as compared with patients who stayed longer. Among the most recent 200 patients, the rate of SDD improved to 52.5%, and in the most recent 100 patients it improved to 65%.
Conclusions: Same-day discharge following RARP can be applied safely in a subset of patients with no increase in readmissions or emergency visits and may lead to significant savings in healthcare costs. To our knowledge, this is only large series examining the safety and feasibility of SDD after RARP reported to date.