Rethinking the Need for Overnight Admission After Robotic-Assisted Laparoscopic Prostatectomy - Beyond the Abstract

There are multiple factors contributing to a progressive decrease in the length of stay (LOS) following radical prostatectomy over the last two decades. These include the rapid transition to minimally invasive surgery, financial pressures in health care delivery, and most recently a global pandemic. While several experienced high-volume surgeons have demonstrated the safety of same-day discharge (SDD), the larger question is whether this practice is safe in diverse hospital settings and by surgeons with varying degrees of experience. 


We examined a recent multi-institutional cohort of patients undergoing robotic prostatectomy in the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database and found that patients discharged the day of surgery had similar rates of hospital re-admission and complications compared to those with a standard length of stay of one to two days. While the retrospective data is subject to limitations, it justifies further prospective study of the practice. More importantly, it highlights that current LOS practices do not seem to be supported by existing data.

Looking forward, we believe that partnering with our patients and establishing objective measures for discharge are critical to success. Patients should be counseled pre-operatively on the plan for SDD so they are mentally prepared for immediate activity after surgery and to ensure there is assistance at home for one to two days. It is also important to establish objective preoperative inclusion criteria and discharge parameters for the post-anesthesia care unit (PACU). Most importantly, patients and family members must demonstrate their ability to return to medical care in the event of an emergency.

It is also worth considering the impact of the COVID-19 pandemic on the management of elective surgical cases. Reducing contacts with the health care system decreases the chance of patients or essential healthcare workers contracting the virus. Thus, transitioning to SDD will improve our ability to continue necessary surgical care in the event of a large second wave or prolonged pandemic. 

We will never eliminate complications from the practice of surgery but should consider changing certain practices given the current healthcare environment. 

Written by: Srinath Kotamarti, MD and Ariel Schulman, MD, Maimonides Medical Center, Brooklyn, New York

Reference:

  1. Kotamarti, Srinath, Thomas Williams, Michael Silver, David A. Silver, and Ariel A. Schulman. "Rethinking the need for overnight admission after robotic-assisted laparoscopic prostatectomy." Journal of Robotic Surgery (2020): 1-3.
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