Outpatient Robotic Radical Prostatectomy: Matched-Pair Comparison with Inpatient Surgery

To evaluate our initial experience with outpatient robotic radical prostatectomy (RRP) and to prospectively compare outcomes with an inpatient RRP group.

We conducted a prospective study on 30 carefully selected, motivated patients consenting for outpatient RRP (2011-2013). Inclusion criteria comprised age<65 years, American Society of Anesthesiologists score<3, body mass index<35 kg/m2, localized prostate cancer, and primary treatment. Postoperatively, close monitoring was conducted by telephone for the first 24 hours, with routine follow-up subsequently. This outpatient group was prospectively matched 1:1 with a concurrent inpatient RRP group who satisfied inclusion criteria for, but did not undergo, outpatient RRP. Validated questionnaires were administered prospectively to determine patient satisfaction and functional outcomes.

All outpatient RRP procedures were performed effectively. Twenty-six patients (87%) were discharged the same day of surgery, four stayed overnight for various reasons. On comparing outpatient and inpatient groups, there were no significant demographic or perioperative differences, except for shorter hospital stay (14 hours vs 44 hours, p<0.01). In both groups, 92% of patients were completely continent (no pads) at 2 months follow-up. Time to complete continence in the outpatient and inpatient groups was 32 days vs 43 days (p=0.09). Validated questionnaires revealed both groups were comparable as regards patient/family satisfaction, days of narcotic usage, days to return to work, and days to feeling 100% recovered.

Our initial experience with outpatient RRP is promising. Outpatient RRP is associated with excellent patient satisfaction and functional outcomes comparable with inpatient RRP. Patient motivation and preoperative counseling are vital for success.