Introduction: The conventional estimated discharge time for a robot-assisted laparoscopic prostatectomy (RALP) is between 24-48 hours. The novel concept of day of surgery (DOS) discharge for RALP has been limited by data to support the surgical feasibility and patient acceptability. This study aims to evaluate patient satisfaction amongst DOS-discharge patients whilst confirming the safety and efficacy of the approach.
Methods: Retrospective analysis was conducted for 100 patients who had undergone DOS RALP, performed by a single surgeon and single site, from June 2015-February 2019. All patients attended a dedicated pre-operative clinic which encourages an enhanced recovery after surgery (ERAS) programme and were aware of intended DOS discharge. Data analysis consisted of pre-operative cancer demographics, intraoperative parameters, and oncological outcomes. Post-operative complications at 30 and 90 days were recorded and reviewed. In addition patient satisfaction was recorded using a questionnaire to assess perceived outcome of overall experience, the quality of information received, post-operative wellbeing and symptom control.
Results: 104 patients were deemed suitable for DOS discharge of these 100 (96%) were discharged on the same day of the surgery. The patient satisfaction survey yielded a 90% response rate. DOS-discharge received an overall positive satisfaction of 87.8% of RALP; 91.2% patients preferred recovery at home. Key satisfaction factors included being happy with pre-operative management (98.4%); good post-operative pain control (94.5%) and no post-operative nausea and vomiting (97.8%).
The median patient age was 63 years (range 48-75) and mean body mass index was 27.4 kg/m2 (range 19.4-36.8). Pre-operative cancer demographics revealed an average PSA 7.4 (1-20.4), Gleason score 6 - 26%, 66% 7 and 8% 8 or above. Clinical tumour stage 47% T1c, 30% T2a, 11% T2b, 8% T2C, 1% T3a and 3% T3b. Overall, 14% had Clavien Dindo I-III complication within 90 days; only 3% required re-admission. Intra-operative average console time was 95 minutes (61-210), with blood loss of 150mls (20-800).83% had a negative surgical margin. There were no 30 day detectable PSA levels and at 90 days 93 % were undetectable.
Conclusions: Overall patient response to DOS-discharge after RALP was very encouraging with excellent perceived recovery from post-operative surgical and anaesthetic parameters. The surgical and oncological outcomes were comparable with non-day case RALP patients and published data. Source of
