Prediction Model for Same-Day Discharge in Robotic-Assisted Radical Laparoscopic Prostatectomy

Introduction: This study aims to develop a predictive model for identifying patients at increased risk of prolonged hospital stay after robotic-assisted radical prostatectomy, either via multi-port or single-port techniques, to improve postoperative care and assist in selecting ideal candidates for same-day discharge. Methods: The study included patients who underwent robotic-assisted radical prostatectomy at the University of Illinois at Chicago between January 2013 and December 2022. The dataset comprises preoperative variables such as age, race, body mass index, comorbidities, prostate-specific antigen levels, Gleason score, surgical approach, and length of hospital stay. A logistic regression model was employed to predict the likelihood of a hospital stay exceeding 24 hours. The model's performance was assessed using the area under the Receiver Operating Characteristic curve and fivefold cross-validation. Results: The predictive model identified significant factors associated with prolonged hospital stays, including body mass index, prostate-specific antigen levels, Gleason score, surgical approach, and specific comorbidities. The transperitoneal approach was strongly associated with lower chances of same-day discharge, demonstrating an odds ratio of 4.23 (p < 0.00001). The model achieved an accuracy of 73.7% as evaluated by cross-validation. Discussion: The nomogram effectively predicts the likelihood of prolonged hospital stay following robotic-assisted radical prostatectomy, enabling surgeons to make informed decisions about patient counseling, surgical planning, and postoperative management. This model may assist in identifying ideal candidates for same-day discharge while improving hospital resource utilization. Future studies should validate this model externally and explore the impact of additional perioperative and social factors.