90-Day readmission after radical prostatectomy-a prospective comparison between robot-assisted and open surgery.

All types of surgery are associated with complications. The debate is ongoing whether robot-assisted radical prostatectomy can lower this risk compared to open surgery. The objective of the present study was to evaluate post-operative adverse events leading to readmissions, using clinical records to classify these adverse events systematically.

A prospective controlled trial of men who underwent robot-assisted laparoscopic (RALP) or retropubic radical prostatectomy (RRP) at 14 departments of Urology (LAPPRO) between 2008 and 2011. Data on all readmissions within 3 months of surgery were collected from the Patient registry, Swedish Board of Health and Welfare. For each readmission the highest Clavien-Dindo grade was listed.

A total of 4003 patients were included in the LAPPRO trial and, after applying exclusion criteria, 3706 patients remained for analyses. The results showed no statistically significant difference in the overall readmission rates (8.1 vs. 7.1%) or readmission due to major complications (Clavien-Dindo ≥3b, 1.7 vs. 1.9%) between RALP and RRP within 90 days after surgery. Patients subjected to lymph-node dissection (LND) had twice the risk for readmission as men not undergoing LND, irrespective RALP or RRP technique. Blood transfusion was significantly more frequent during and within 30 days of RRP surgery (16 vs. 4%). Abdominal symptoms were more common after RALP.

There is a substantial risk for hospital readmission after prostate-cancer surgery, regardless of technique; although major complications are rare. Regardless of surgical technique, attention should be focused on specific types of complications.

Scandinavian journal of urology. 2019 Feb 06 [Epub ahead of print]

Anna Wallerstedt Lantz, Johan Stranne, Stavros I Tyritzis, David Bock, David Wallin, Hanna Nilsson, Stefan Carlsson, Thordis Thorsteinsdottir, Ove Gustafsson, Jonas Hugosson, Anders Bjartell, Peter Wiklund, Gunnar Steineck, Eva Haglind

a Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet, Stockholm , Solna , Sweden., b Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden., c Department of Surgery, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden., d Landspitali National University Hospital and the Faculty of Nursing , University of Iceland , Reykjavic , Iceland., e Department of Clinical Science, Intervention and Technology , Karolinska Institutet, Stockholm , Solna , Sweden., f Department of Urology , Skåne University Hospital, Lund University , Lund , Sweden., g Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.

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