Outpatient Robot-assisted Radical Prostatectomy: A Feasibility Study

Area of Science:

• Urology
• Surgical Oncology
• Anesthesiology

Background:

• Prostate cancer is a leading cancer in men, with surgical techniques evolving towards less invasive robotic-assisted radical prostatectomy (RARP).
• Advancements in surgical and anesthetic techniques have paved the way for exploring outpatient procedures, including RARP.

Purpose of the Study:

• To assess the feasibility of routine outpatient management following robotic-assisted radical prostatectomy.
• To identify potential risk factors for delayed discharge after RARP.

Main Methods:

• An observational, prospective, monocentric study included 97 patients undergoing RARP by a single experienced surgeon.
• Discharge readiness was evaluated using the Post Anesthesia Discharge Scoring System (PADSS), aiming for a score of 9 or higher.
• Risk factors for delayed discharge were secondarily analyzed.

Main Results:

• Only 1 patient met discharge criteria on the day of surgery (day 0).
• 74% of patients achieved discharge criteria by postoperative day 1, with 33% and 66% discharged by days 2 and 3, respectively.
• Patients discharged on day 1 reported significantly less postoperative nausea and vomiting compared to those discharged later (7% vs. 28%, P=.01).

Conclusions:

• Routine outpatient management is not currently feasible for the majority of patients undergoing RARP.
• Discharge on postoperative day 1 is a conceivable goal, particularly with effective management of postoperative nausea and vomiting.
• Further research is needed to confirm the potential for outpatient RARP and optimize patient selection and care pathways.