When Outpatient Becomes Inpatient: Predictors of Failure of Same-Day Discharge After Robotic Single-Port Urologic...

Same-day discharge (SDD) after robotic single-port (SP) urologic surgery is increasingly adopted, yet a subset of patients still requires unplanned hospitalization. Identifying predictors of outpatient protocol failure is essential to improve patient selection and perioperative pathways.

We retrospectively analyzed 291 consecutive patients who underwent SP urologic surgery between January 2023 and June 2025, including radical prostatectomy, simple prostatectomy, partial nephrectomy, and reconstructive procedures. All patients were scheduled for SDD. Those requiring at least 1 overnight stay were classified as inpatients. Demographic, perioperative, and surgical variables were compared between groups using univariate analyses. Significant variables were entered into a multivariable logistic regression model to identify independent predictors of outpatient failure. A smoothed probability curve was generated to evaluate the association between operation end time and SDD probability.

Overall, 237 patients (81.4%) achieved SDD, whereas 54 (18.6%) required hospitalization. Multivariate analysis identified later operation end time (P < .001), intraoperative complications (P = .002), drain placement (P = .016), postoperative narcotic use (P < .001), transfusion (P = .028), and depression (P = .045) as independent predictors of failure of the SDD protocol.

Approximately 1 in 5 patients scheduled for outpatient SP surgery required admission. Both clinical and logistical factors significantly influenced SDD failure. Optimized patient selection and perioperative management may further enhance safety and expand SDD adoption in robotic urologic surgery.