However, the question of whether RARP can be performed safely as an outpatient procedure remains a critical one, particularly as healthcare systems seek to reduce costs and improve patient convenience. Our recent systematic review and meta-analysis, "A comparison of surgical outcomes between outpatient and inpatient robot-assisted radical prostatectomy," aimed to address this gap by evaluating the perioperative, oncological, and functional outcomes of outpatient RARP (O-RARP) compared to inpatient RARP (I-RARP).
In this analysis, we reviewed 11 studies encompassing 2,875 RARP cases (892 O-RARP and 1,983 I-RARP). We found that patients who had outpatient RARP (O-RARP):
- Had shorter operative times (MD = -9.4 minutes, 95% CI -15.1 to -3.7, P = 0.001)
- Had shorter lengths of stay (MD = -22.9 hours, 95% CI -26.0 to -19.7, P < 0.001)
- Experienced fewer overall postoperative complications (RR = 0.65, 95% CI 0.46 to 0.92, P = 0.017)
- Required fewer opioids postoperatively (RR = 0.45, 95% CI 0.28 to 0.71, P = 0.001)
It is important to note that the key distinction between O-RARP and I-RARP lies in the discharge pathway, not the surgical technique itself. This means that patient selection and perioperative management are critical to achieving successful same-day discharge without compromising patient safety or outcomes.
Looking ahead, the adoption of O-RARP presents an opportunity for cost savings and improved patient throughput, aligning well with the growing emphasis on value-based healthcare. However, patient selection remains a critical factor. Ideal candidates for O-RARP are those with low-risk prostate cancer, good overall health, and strong social support at home. Further studies are needed to refine these criteria and assess the long-term cost-effectiveness of this approach in diverse healthcare settings.
We hope this work contributes to the ongoing discussion about the future of robotic surgery and encourages further exploration of outpatient pathways in urologic oncology.
Written by:
- Muhammed A. Moukhtar Hammad, MD, Department of Urology, University of California Irvine, Orange, CA
- Tuan Thanh Nguyen, MD, Department of Urology, Cho Ray Hospital, Ho Chi Minh City, Vietnam, Lecturer, University of Medicine and Pharmacy at Ho Chi Minh City
- Mohammed Shahait, MD, Surgery Department, Clemenceau Medical Center Dubai, United Arab Emirates
- David Lee, MD, FACS, Professor of Urology, Vice Chair of Academic Affairs and Clinical Operations, Department of Urology, University of California Irvine, Director, Robotic Urological Surgery Fellowship, Director, Comprehensive Prostate Cancer Program, Orange, CA