Successful same-day discharge for robot-assisted radical prostatectomy: A systematic review and meta-analysis.

Abstract

238 Background: In the current era of enhanced recovery after surgery (ERAS), same day discharge (SDD) following robot-assisted radical prostatectomy (RARP) is emerging as the standard of care. In order to implement a safe and efficient SDD pathway, it is imperative to appropriately select candidates and have established discharge criteria. We conducted a systematic review and meta-analysis to summarize published pathways, as well as to evaluate the differences in peri-operative characteristics, complication/readmissions rates, and satisfaction/cost data, between in-patient (IP) RARP versus SDD-RARP. Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered with PROSPERO (CRD42021258848). A comprehensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, Google Scholar, and conference abstract publications was performed comparing outcomes between IP-RARP and SDD-RARP. A leave-one-out sensitivity analyses was performed to control for heterogeneity and risk of bias. Results: A total of 14 studies (eight prospective and six retrospective cohort studies) were included with a pooled population of 3795 patients, including 2348 (61.9%) IP-RARPs and 1447 (38.1%) SDD-RARPs. SDD pathways varied, though many commonalities were present in patient selection (minimal comorbidities and lived close to the hospital [≤ 50-150 km]), peri-operative recommendations (judicious intra-operative intravenous fluids and short-acting narcotics), and post-operative management (immediate ambulation and diet, and non-narcotic analgesia). When compared to IP-RARP, SDD-RARP had no differences in ≥ Grade 3 Clavien–Dindo complications (RR: 0.4, 95% CI 0.2, 1.1, p = 0.07), 90-day readmission rates (RR: 0.6, 95% CI 0.3, 1.1, p = 0.10), or unscheduled ED visits (RR: 1.0, 95% CI 0.3, 3.1, p = 0.97). Cost savings per patient ranged between $367-2109 (USD), and overall satisfaction was high between 87.5-100%. Conclusions: Same day discharge following RARP is both feasible and safe, with comparable complication and readmission rates to IP-RARP. Additionally, SDD offers healthcare cost-savings with high patient satisfaction rates. Data from this study will further inform the uptake and development of future SDD pathways in contemporary urological care such that it may be offered to a broader patient population.