Predictors of Prolonged Time to Ambulation After Radical Prostatectomy in a 23-hour Ambulatory Surgery Center

The purpose of this study was to identify factors associated with delayed ambulation in patients undergoing radical prostatectomy in an ambulatory surgery setting.

Patients who underwent ambulatory robot-assisted radical prostatectomy between January 11, 2016, and December 27, 2022, were eligible for inclusion. Predictors of interest included age, body mass index (BMI), American Society of Anesthesiologists physical status (1/2 vs 3/4), operative time, volume of intravenous fluids, estimated blood loss, intraoperative oral morphine equivalents, and postoperative nausea and vomiting (PONV) risk using 4-point Apfel scoring.

The cohort included 3626 patients who underwent ambulatory prostatectomy. Median time to ambulation was 5.1 hours (IQR 4.2-6.3). Among predictors, only BMI and Apfel score were statistically significantly associated with ambulation. Patients with higher BMI were more likely to ambulate the same day of surgery; however, the effect size was small: A man with PONV risk score 2 and BMI 25 has a 94% chance of ambulating the same day compared with 95% for a man with BMI 30. A PONV risk score of 3 was associated with more than double the odds of next-day ambulation compared with scores ≤ 2 (odds ratio, OR 2.18, 95% confidence interval, CI, 1.69-3.66, P = .006).

Our study identified an association between preoperative PONV risk score and delayed ambulation. Although high PONV risk is more commonly observed in women, our findings suggest that awareness of PONV risk and its management on postoperative ambulation should also be investigated in the context of prostate surgery.