Portal de Periódicos da CAPES

Successful Same-Day Discharge for Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis

2022; Lippincott Williams & Wilkins; Volume: 9; Issue: 4 Linguagem: Inglês

10.1097/upj.0000000000000305

2352-0787

Michael Uy, Braden Millan, Conor Jones, David Sands, Edward D. Matsumoto, Benjamin Bay, Bobby Shayegan,

Pelvic and Acetabular Injuries

No AccessUrology PracticeBusiness1 Jul 2022Successful Same-Day Discharge for Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-AnalysisThis article is commented on by the following:Editorial CommentaryEditorial CommentaryEditorial Commentary Michael Uy, Braden Millan, Conor Jones, David Sands, Edward Matsumoto, Benjamin Bay, and Bobby Shayegan Michael UyMichael Uy https://orcid.org/0000-0001-9426-7360 Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada , Braden MillanBraden Millan Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada , Conor JonesConor Jones Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada , David SandsDavid Sands Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada , Edward MatsumotoEdward Matsumoto Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada Department of Urology, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada , Benjamin BayBenjamin Bay Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada Department of Urology, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada , and Bobby ShayeganBobby Shayegan *Correspondence: Division of Urology, Department of Surgery, McMaster University, 50 Charlton Ave. E, G343 Hamilton, Ontario, Canada L8N4A6 telephone: 905-522-1155, ext. 33982; FAX: 905-308-7210; email address: E-mail Address: [email protected] Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada Department of Urology, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000305AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Introduction: Same-day discharge (SDD) following robot-assisted radical prostatectomy (RARP) is emerging as the standard of care. We conducted a systematic review and meta-analysis to evaluate the differences in perioperative characteristics, complication/readmissions rates and satisfaction/cost data between inpatient (IP) RARP and SDD RARP. Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was prospectively registered with PROSPERO (CRD42021258848). A comprehensive search of PubMed®, Embase®, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and conference abstract publications was performed. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. Results: A total of 14 studies were included with a pooled population of 3,795 patients, including 2,348 (61.9%) IP RARPs and 1,447 (38.1%) SDD RARPs. SDD pathways varied, though many commonalities were present in patient selection, perioperative recommendations and postoperative management. When compared to IP RARP, SDD RARP had no differences in ≥grade 3 Clavien–Dindo complications (RR: 0.4, 95% CI 0.2, 1.1, p=0.07), 90-day readmission rates (RR: 0.6, 95% CI 0.3, 1.1, p=0.10) or unscheduled emergency department visits (RR: 1.0, 95% CI 0.3, 3.1, p=0.97). Cost savings per patient ranged between $367 and $2,109, and overall satisfaction was high at 87.5%–100%. Conclusions: SDD following RARP is both feasible and safe, while potentially offering health care cost savings with high patient satisfaction rates. Data from this study will inform the uptake and development of future SDD pathways in contemporary urological care such that it may be offered to a broader patient population. References 1. : Clinical efficacy of enhanced recovery after surgery (ERAS) program in patients undergoing radical prostatectomy: a systematic review and meta-analysis. World J Surg Oncol 2020; 18: 131. Google Scholar 2. : Outpatient prostatectomy: too much too soon or just what the patient ordered. Urology 2010; 75: 421. Google Scholar 3. : Same-day discharge for patients undergoing robot-assisted laparoscopic radical prostatectomy is safe and feasible: results of a pilot study. J Endourol 2016; 30: 1296. Google Scholar 4. : Safety and feasibility of outpatient robot-assisted radical prostatectomy. J Robot Surg 2019; 13: 261. Google Scholar 5. : Outpatient robotic radical prostatectomy: matched-pair comparison with inpatient surgery. J Endourol, suppl., 2016; 30: S52. Google Scholar 6. : Predictors associated with a prolonged hospital stay after single-port extraperitoneal robotic radical prostatectomy: a comparative analysis of outpatient versus inpatient care. J Endourol 2020; 34: 1049. Google Scholar 7. : Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. Updated March 2011. Hoboken, New Jersey: Wiley Cochrane 2011. Google Scholar 8. : Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097. Google Scholar 9. : Multi-institutional assessment of routine same day discharge surgery for robot-assisted radical prostatectomy. J Urol 2020; 204: 956. Link, Google Scholar 10. : Same-day discharge surgery for robot-assisted radical prostatectomy in the era of ERAS and prehabilitation pathways: a contemporary, comparative, feasibility study. World J Urol 2020; https://doi.org/10.1007/s00345-020-03119-w. Google Scholar 11. : Rethinking the need for overnight admission after robotic-assisted laparoscopic prostatectomy. J Robot Surg 2020; 14: 913. Google Scholar 12. : Perioperative mortality and morbidity of outpatient versus inpatient robot-assisted radical prostatectomy: a propensity matched analysis. Urol Oncol Semin Orig Investig 2020; 38: 3.e1. Google Scholar 13. Veritas Health Innovation: Covidence Systematic Review Software. Melbourne, Australia: Veritas Health Innovation 2020. Available at www.covidence.org. Google Scholar 14. : Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14: 1. Google Scholar 15. : The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250: 187. Google Scholar 16. : Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 2003; 73: 712. Google Scholar 17. : Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice. J Heal Serv Res Pol 2002; 7: 51. Google Scholar 18. : Same day discharge after robotic radical prostatectomy. J Urol 2019; 202: 959. Link, Google Scholar 19. : Ambulatory robot-assisted laparoscopic prostatectomy: is it ready for prime time? A quality of life analysis. J Endourol 2019; 33: 814. Google Scholar 20. : Same day discharge versus inpatient surgery for robot-assisted radical prostatectomy: a comparative study. J Clin Med 2021; 10: 661. Google Scholar 21. : Experience of day case robotic prostatectomy. About thirty-two patients. Prog Urol 2019; 29: 619. Google Scholar 22. : Outpatient extraperitoneal single-port robotic radical prostatectomy. Urology 2020; 144: 142. Google Scholar 23. : A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth 1995; 7: 500. Google Scholar 24. : Outpatient robot-assisted radical prostatectomy: a feasibility study. Urology 2019; 128: 16. Google Scholar 25. : One-day prehabilitation program before robotic radical prostatectomy in daily practice: routine feasibility and benefits for patients and hospitals. Eur Urol Open Sci 2020; 21: 14. Google Scholar 26. : Trends in immediate perioperative morbidity and delay in discharge after open and minimally invasive radical prostatectomy (RP): a 20-year institutional experience. BJU Int 2013; 112: 45. Google Scholar 27. : Exploring pathways towards improving patient experience of robot-assisted radical prostatectomy (RARP): assessing patient satisfaction and attitudes. BJU Int 2018; 121: 33. Google Scholar Support: None. Conflict of Interest: The authors have no conflicts of interest to disclose. Ethics Statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study (systematic review) formal consent is not required. PROSPERO Protocol No.: CRD42021258848. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology Practice12 May 2022Editorial CommentaryUrology Practice12 May 2022Editorial CommentaryUrology Practice12 May 2022Editorial Commentary Volume 9Issue 4July 2022Page: 294-305Supplementary Materials Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordsambulatory surgical proceduressystematic reviewprostatectomyrobotic surgical proceduresoutpatientsMetricsAuthor Information Michael Uy Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada More articles by this author Braden Millan Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada More articles by this author Conor Jones Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada More articles by this author David Sands Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada More articles by this author Edward Matsumoto Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada Department of Urology, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada More articles by this author Benjamin Bay Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada Department of Urology, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada More articles by this author Bobby Shayegan Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada Department of Urology, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada *Correspondence: Division of Urology, Department of Surgery, McMaster University, 50 Charlton Ave. E, G343 Hamilton, Ontario, Canada L8N4A6 telephone: 905-522-1155, ext. 33982; FAX: 905-308-7210; email address: E-mail Address: [email protected] More articles by this author Expand All Support: None. Conflict of Interest: The authors have no conflicts of interest to disclose. Ethics Statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study (systematic review) formal consent is not required. PROSPERO Protocol No.: CRD42021258848. Advertisement PDF downloadLoading ...