Comparison of same-day discharge robotic-assisted radical prostatectomy in an ambulatory surgery center versus hospital setting

Robotic-Assisted Radical Prostatectomy (RARP) is the predominant surgical approach for localized prostate cancer in the United States and over 50% of RARP are performed as ambulatory or same-day discharge encounters. Current literature supports that RARP performed in the outpatient setting are as effective and have no increase in complications compared to those performed inpatient and cost nearly 20% less than those performed inpatient. Between May 2021 and December 2021, two-high volume robotic surgeons at an independent multi-specialty physician group performed RARP in both a freestanding ambulatory surgery center (ASC) and in an affiliated hospital. Data on demographics, clinical and pathological variables, operative metrics, outcomes, and complications were collected. Analysis involved the use of descriptive statistics, t-tests for continuous variables, and Chi-Square analysis and Fisher's tests for categorical variables. 40 ASC cases and 50 hospital cases were identified. There were no significant differences in mean age, BMI, PSA, prostate volume, and final pathological stage between groups. The hospital group had higher grade group classification. There were no significant differences in ASA classification, estimated blood loss, operative time, or complications between groups. The hospital group had higher recovery time and length of stay. There were no readmissions in either group. RARP performed in an ASC demonstrated outcomes comparable to those performed in a hospital. These findings are consistent with published evidence that outpatient RARP are safe and cost-effective, supporting reconsideration of current CMS reimbursement policies that restrict access to ambulatory surgical care for prostate cancer.