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Retzius-Sparing Robot-Assisted Radical Prostatectomy

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Published on: May 19, 2022

Single-night stay for open radical prostatectomy.

Gregory J Nason¹, Justin K Kim¹, Guan HeeTan¹

¹Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON, Canada.

Canadian Urological Association Journal = Journal De L'Association Des Urologues Du Canada

|August 19, 2020

Summary

An enhanced care pathway significantly reduced length of stay for open radical prostatectomy (RP) to a single night, proving safe and effective. This pathway improved surgical outcomes without increasing readmissions.

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Area of Science:

Urology
Surgical Oncology
Health Services Research

Background:

Robotic-assisted laparoscopic prostatectomy (RALP) is not universally available in Canada.
Open radical prostatectomy (RP) remains a common procedure.
Optimizing patient recovery and hospital resource utilization is crucial.

Purpose of the Study:

To evaluate the impact of an enhanced care pathway on length of stay (LOS) for open radical prostatectomy (RP).
To determine if a single-night stay is feasible and safe for patients undergoing open RP.
To assess the pathway's effect on intraoperative outcomes and post-discharge complications.

Main Methods:

Retrospective review of open radical prostatectomy (RP) cases performed between 2005 and 2019.
Comparison of outcomes before (2005-2010) and after (2011-2019) the implementation of an enhanced care pathway.
Analysis of length of stay, intraoperative blood loss, surgical drain use, emergency department visits, and readmission rates.

Main Results:

The enhanced care pathway significantly decreased intraoperative blood loss (350ml to 200ml) and surgical drain use (90% to 9.5%).
Median length of stay (LOS) for open RP decreased from 3 days to 1 day post-pathway implementation.
93% of patients were discharged on day 1 after surgery, with no significant increase in emergency department visits or 30-day readmissions.

Conclusions:

A single-night hospital stay is safe and achievable for the majority of patients undergoing open radical prostatectomy (RP).
A dedicated, multifaceted enhanced care pathway is essential for achieving safe and timely patient discharge.
This pathway optimizes recovery and resource utilization in open RP.