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Ploussard G, Loison G, Almeras C, Gautier JR, Cazali P, Tollon C, Beauval JB, Salin A. One-day Prehabilitation Program Before Robotic Radical Prostatectomy in Daily Practice: Routine Feasibility and Benefits for Patients and Hospitals. EUR UROL SUPPL 2020; 21:14-16. [PMID: 34337463 PMCID: PMC8317858 DOI: 10.1016/j.euros.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Guillaume Loison
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Almeras
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | - Priscilla Cazali
- Prehabilitation Program, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | - Ambroise Salin
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
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Ploussard G, Almeras C, Beauval JB, Gautier JR, Garnault V, Frémont N, Dallemagne S, Loison G, Salin A, Tollon C. A combination of enhanced recovery after surgery and prehabilitation pathways improves perioperative outcomes and costs for robotic radical prostatectomy. Cancer 2020; 126:4148-4155. [PMID: 32639601 DOI: 10.1002/cncr.33061] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND An enhanced recovery after surgery (ERAS) pathway has shown benefit in oncologic surgery. However, literature is scarce regarding the impact of this pathway, alone or combined with prehabilitation (PreHab) programs, on outcomes after robot-assisted radical prostatectomy (RARP). METHODS Included in this study were 507 consecutive patients undergoing RARP from 2014 to 2019. The primary endpoint was duration of hospital stay. Secondary outcomes included intraoperative blood loss, operative duration, readmission rate, and overall costs. Univariate and multivariate comparisons were performed according to the ERAS and PreHab program status. RESULTS ERAS patients had shorter hospital stays (P < .001), reduced operative times (P < .001), and decreased blood loss (P < .001) in comparison with non-ERAS patients. Shorter hospital stays were not associated with an increased readmission rate (7.9% [stable over time]; P = .757). Patients from an ERAS-/PreHab- group had a longer hospital stay (4.7 days) than those from an ERAS+/PreHab- group (3.5 days) and those from an ERAS+/PreHab+ group (1.6 days; P < .001). In a multivariate analysis, operative time and perioperative pathway (odds ratio for ERAS, 0.144; P < .001; odds ratio for ERAS and PreHab, 0.025; P < .001) were independently predictive for a prolonged length of stay (P < .001). Costs significantly decreased when ERAS and PreHab pathways were combined. CONCLUSIONS The implementation of ERAS and PreHab programs significantly changes the postoperative course of patients and may synergistically optimize RARP outcomes. The combination of these pathways improves patient recovery and is associated with reduced lengths of stay, blood loss, operative times, and costs without an increase in the postdischarge readmission rate.
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Affiliation(s)
| | - Christophe Almeras
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | | | | | - Valérie Garnault
- Department of Public Health, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | | | | | - Guillaume Loison
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | - Ambroise Salin
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | - Christophe Tollon
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France
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Ploussard G, Almeras C, Beauval JB, Gautier JR, Loison G, Salin A, Tollon C. Same-day discharge surgery for robot-assisted radical prostatectomy in the era of ERAS and prehabilitation pathways: a contemporary, comparative, feasibility study. World J Urol 2020; 40:1359-1365. [PMID: 32065277 DOI: 10.1007/s00345-020-03119-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To assess the feasibility of same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) in the context of enhanced recovery after surgery (ERAS) and prehabilitation pathways. MATERIALS AND METHODS For 1 year, we prospectively assessed the feasibility of SDD RARP in the context of ERAS and prehabilitation pathways. SDD patients were compared to overnight patients operated during the same period by the same surgeon. Primary outcomes were complication and 90-day readmission rates. RESULTS Of the overall cohort, 51.9% were discharged home the day of surgery. Both cohorts were comparable in terms of pre-operative and intra-operative characteristics. There was a not significant trend towards shorter operative time in the SDD cohort (93.7 versus 105.2 min, p = 0.077). Mean blood loss was comparable between both cohorts. No significant difference in terms of complication (p = 0.606; 16.0% versus 11.1%) and readmission rates (< 4%) was noted. There was a not significant trend towards faster continence recovery for patients included in the SDD cohort, compared with those in the inpatient cohort. The overall cost per patient was reduced by 10.8% with SDD surgery with no increased cost due to emergency visits or readmissions CONCLUSIONS: Implementation of SDD RARP in the context of ERAS and prehabilitation pathways is safe, reduces cost and does not compromise the post-operative course. 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 has to be confirmed in a larger cohort.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Toulouse, 52, chemin de Ribaute, 31130, Quint Fonsegrives, France.
| | - Christophe Almeras
- Department of Urology, La Croix du Sud Hospital, Toulouse, 52, chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Jean-Baptiste Beauval
- Department of Urology, La Croix du Sud Hospital, Toulouse, 52, chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Jean-Romain Gautier
- Department of Urology, La Croix du Sud Hospital, Toulouse, 52, chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Guillaume Loison
- Department of Urology, La Croix du Sud Hospital, Toulouse, 52, chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Ambroise Salin
- Department of Urology, La Croix du Sud Hospital, Toulouse, 52, chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Christophe Tollon
- Department of Urology, La Croix du Sud Hospital, Toulouse, 52, chemin de Ribaute, 31130, Quint Fonsegrives, France
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Reynolds BR, Bulsara C, Zeps N, Codde J, Lawrentschuk N, Bolton D, Vivian J. Exploring pathways towards improving patient experience of robot-assisted radical prostatectomy (RARP): assessing patient satisfaction and attitudes. BJU Int 2019; 121 Suppl 3:33-39. [PMID: 29603580 DOI: 10.1111/bju.14226] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine patient satisfaction and experience after robot-assisted radical prostatectomy (RARP) for prostate cancer, using a convergent mixed-method qualitative analysis approach. PATIENTS AND METHODS 412 patients who underwent RARP between January 2014 and June 2016 were mailed questionnaires and invited to participate in focus groups. Qualitative data was thematically analysed using NVivo. Descriptive statistics were obtained from the questionnaire using SPSS. RESULTS 214 patients responded (52% of sample size) of whom 97.6% were satisfied and 91.1% would likely recommend RARP. Key themes from the qualitative data highlighted the psychosocial impacts of the diagnosis and RARP process. The importance of early recovery, the benefits of pelvic floor exercises and educational resources were emphasised. CONCLUSION Patients were overwhelmingly satisfied with RARP, largely due to relevance and timeliness of the information and support provided both before and after surgery. With an increased understanding of the factors and outcomes that are most important to patients regarding all aspects of hospital care, we can create more targeted care pathways. Key themes will help inform the implementation of an enhanced recovery after surgery (ERAS) protocol to further improve recovery and early return to function.
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Affiliation(s)
- Bradley R Reynolds
- School of Medicine, University of Notre Dame Fremantle, Fremantle, WA, Australia.,Department of Medical Research, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Fremantle, Fremantle, WA, Australia
| | - Nik Zeps
- School of Medicine, University of Notre Dame Fremantle, Fremantle, WA, Australia.,Department of Medical Research, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Fremantle, Fremantle, WA, Australia
| | | | - Damien Bolton
- Department of Urology, Austin Health, Melbourne, Vic., Australia
| | - Justin Vivian
- Department of Urology, St John of God Subiaco Hospital, Subiaco, WA, Australia
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