The typical mean length of stay (LOS) following robotic-assisted laparoscopic prostatectomy (RALP) is 24-48hrs. We began routinely offering same day discharge (SDD) after RALP and evaluate the success rate, safety and cost implications in the only large series of SDD to date.
Beginning September 2016, all patients were given the option for SDD without it being mandated. After allowing a period of 3 months to solidify the protocol, we evaluated our prospective database for the next 500 patients.
Of 500 consecutive RALPs by one surgeon (RA) in 18mos, 246 patients (49.2%) were discharged the day of surgery with all of the remaining 254 discharged the next day for a mean LOS of 0.51 days. Mean age was 62yrs (42-81yrs) and BMI 29.7kg/m2 (20-53kg/m2). Thirty-four (6.8%) overall had a Clavien-Dindo grade I-III complication within 90 days with no grade IV-V complications. Only 5 required an emergency department (ED) visit (1%) and only 8 required readmission (1.6%). Among SDD patients, only one was readmitted, and only one presented to the ED. The estimated charge for overnight stay at our institution is $2,109, such that the approximate reduction in charges was $518,814 over 18 months ($345,876/yr) with no increase in costs from ED visits or readmissions compared with overnight patients. Among the most recent 100 patients, the rate of SDD improved to 65%.
Same-day discharge following RALP can be safely routinely offered with no increase in readmissions or emergency visits and may lead to significant savings in healthcare costs.
The Journal of urology. 2019 May 21 [Epub ahead of print]
Ronney Abaza, Oscar Martinez, Matthew C Ferroni, Aya Bsatee, Robert S Gerhard
Robotic Surgery, OhioHealth Dublin Methodist Hospital , Dublin , OH., Ohio University Heritage College of Osteopathic Medicine , Dublin , OH.