Same-Day Discharge Surgery for Robot-Assisted Radical Prostatectomy in the Era of ERAS and Prehabilitation Pathways: A Contemporary, Comparative, Feasibility Study - Beyond the Abstract

The feasibility of same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) remains controversial in spite of the post-operative course obtained by robotic and minimally invasive techniques. Few series have been published in the literature regarding the impact after prostate cancer surgery, and mainly by US teams. Indeed, the length of stay remains strongly dependent on the healthcare system.

In parallel, the developments of ERAS® and prehabilitation programs in oncology surgery may improve patient preparation for surgery and may lead to a wider acceptance of SDD. This has been demonstrated in colorectal, bladder, and pancreatic surgery.

Here, we report our experience of the implementation of SDD for RARP in the context of a French health care system that does not encourage early discharge.

The novelty of this study was the previous implementation for all patients of a prehabilitation pathway aiming at preparing patient at the best for the SDD. This program involved a multidisciplinary team of caregivers (psychologists, physiotherapists, specialized nurses, and dieticians).

Thus, to our knowledge, this study is the first to assess the feasibility of SDD for RARP in the context of an optimized peri-operative program that included ERAS® and prehabilitation pathways.

We found that the implementation of SDD RARP in the context of ERAS® and prehabilitation pathways is safe, reduces cost and does not compromise the post-operative course. The proportion of patients undergoing SDD continuously increased to reach 60% of the surgeon cohort at the end of the study period. The trend suggesting a faster continence recovery after SDD is also interesting (the faster, the better) and has to be confirmed in a larger cohort. Cost savings achieved by SDD may have wider implications when considering the national healthcare system level.

Written by: Guillaume Ploussard, MD, PhD, Urologist, Robotic Surgeon, Institut Universitaire du Cancer, La Croix du Sud Hospital, Toulouse, France.

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