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Faria EF, Machado RD, Gualberto RJC, Milani MAV, Bidinotto LT, Machado MT, Dos Reis R, Bidinotto DNPB. Patient's safety and satisfaction on same day discharge after robotic and laparoscopic radical prostatectomy versus discharge after 24 or 48 h: a longitudinal randomized prospective study. BMC Urol 2023; 23:149. [PMID: 37735383 PMCID: PMC10512494 DOI: 10.1186/s12894-023-01318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND There is a tendency of prompted global health systems to reduce the length of hospital stay without compromising patient safety or satisfaction. We evaluated the safety and viability of early discharge in patients undergoing minimally invasive radical prostatectomy (MIRP), as well as patient satisfaction with this strategy. METHODS This longitudinal prospective study included 72 patients who underwent MIRP for prostate cancer. Three groups were performed according to the day of hospital discharge following surgery: same day (G1), first day after (G2), and second day after (G3). Satisfaction, adverse events, and readmission were analyzed for each group. Associations between clinicopathologic variables and same-day discharge were analyzed by comparing data between G1 patients who did and did not achieve same-day discharge. RESULTS 16.7% of patients were not discharged according to randomization (10 randomized to G1). 80% of G1 patients who did not achieve same-day discharge had Gleason scores of 3 + 4 or 4 + 3, which were observed in 35.7% of patients discharged on the same day (P < 0.05). Average prostate weight was significantly lower in patients who achieved same-day discharge than in those who did not (P < 0.01). Univariable logistic regression points to Gleason scores of 3 + 4 or 4 + 3 as the main factors associated with unsuccessful same-day discharge (P < 0.05). There were no significant differences in satisfaction scores. CONCLUSIONS Same-day discharge was both safe and feasible and does not appear to affect satisfaction in a subset of patients with prostate cancer. Surgeons should consider the Gleason score when determining whether same-day discharge is appropriate.
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Affiliation(s)
| | - Roberto Dias Machado
- Department of Urology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, S. Paulo, CEP 14784 400, Brazil
| | | | | | - Lucas Tadeu Bidinotto
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- School of Medicine, Department of Pathology, UNESP - Univ. Estadual Paulista, Botucatu, São Paulo, Brazil
- Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, Brazil
| | | | - Ricardo Dos Reis
- Department of Gynecology, Barretos Cancer Hospital, Barretos, Brazil
| | - Daniele Natália Pacharone Bertolini Bidinotto
- Department of Urology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, S. Paulo, CEP 14784 400, Brazil.
- Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, Brazil.
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Reddy S, Noel J, Moschovas M, Bhat KRS, Perera R, Rogers TP, Stirt D, Doss J, Jenson C, Andrich J, Patel V. Same Day Discharge Protocol for Robotic Assisted Radical Prostatectomy: the experience of a High-Volume Referral Center. J Endourol 2022; 36:934-940. [PMID: 35166120 DOI: 10.1089/end.2021.0730] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective As the COVID-19 global pandemic continues, there is increased value in performing same-day discharge (SDD) protocols to minimize viral exposure and maintain the appropriate surgical treatment for oncological patients. In this scenario, we performed a prospective analysis of outcomes of our patients undergoing SDD protocol after robotic-assisted radical prostatectomy (RARP). Material and Methods The SDD criteria included patients with no intraoperative complications, stable postoperative hemoglobin levels (compared to preoperative values), stable vital signs, normal urine output, ambulation with assistance and independently without dizziness, tolerance of clear liquids without nausea or vomiting, pain control with oral medication, and patient/family confidence with SDD. Patients older than 70 years, concomitant general surgery operations, multiple comorbidities, and complex procedures such as salvage surgery were excluded from our protocol. Results Of the 101 patients who met the criteria for SDD, 73 (72%) had a successful SDD. All SDF (Same day discharge failure) patients were discharged one day after surgery. Intraoperative characteristics were not statistically different with a median operative time of 92 (81-107) vs 103 (91-111) minutes for SDD and SDF respectively. Of the 28 SDF patients, the most common reasons for staying were anesthesia-related factors of nausea (35%), drowsiness (7%), patient/caregiver preference (25%), pain (14%), labile blood pressure (7%), arrhythmia (7%), and dizziness (7%). There was no significant difference in readmission rates, complication rates, or post-operative pain scores between SDD and SDF patients. Conclusions In our experience, SDD for patients undergoing RARP can be safely and feasibly incorporated into a clinical care pathway without increasing readmission rates. We were successful in 72% of cases due to coordinated care between anesthetics, nursing staff, and appropriate patient selection. We also believe that incorporating pre-and postoperative patient education and assurance is crucial to minimize their exposure to COVID-19 during the surgical treatment for prostate cancer.
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Affiliation(s)
- Sunil Reddy
- Global Robotic Institute, Urology, Celebration, Florida, United States;
| | - Jonathan Noel
- AdventHealth Global Robotics Institute, Urology, Celebration, Florida, United States;
| | - Marcio Moschovas
- AdventHealth, 6245, Urology, Celebration, Florida, United States;
| | - Kulthe Ramesh Seetharam Bhat
- AdventHealth Global Robotics Institute, Urology, 400 Celebration place, suite 200, celebration, Florida, United States, 34747.,Global robotics institute;
| | - Roshane Perera
- University of Florida, 3463, Gainesville, Florida, United States;
| | - Travis Phillip Rogers
- Florida Hospital Celebration Health, 23067, 410 Celebration Pl, Celebration, Florida, United States, 34747-4970.,United States;
| | - Daniel Stirt
- University of Central Florida, 6243, Medicine, Orlando, Florida, United States;
| | - Janice Doss
- Adventhealth Global Robotics Institute, Florida, United States;
| | - Cathy Jenson
- Florida Hospital Celebration Health, 23067, 410 Celebration p, Suite 200, Celebration, Florida, United States, 34747;
| | - John Andrich
- Adventhealth Global Robotics Institute, Florida, United States;
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Urology, Celebration, Florida, United States;
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Kotamarti S, Williams T, Silver M, Silver DA, Schulman AA. Rethinking the need for overnight admission after robotic-assisted laparoscopic prostatectomy. J Robot Surg 2020; 14:913-915. [PMID: 32602024 PMCID: PMC7322390 DOI: 10.1007/s11701-020-01115-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
Robotic-assisted laparoscopic prostatectomy (RALP) is the gold standard for the surgical management of localized prostate cancer (PCa). Multi-institutional series have demonstrated complications and readmissions in less than 5% of patients and most are now discharged within 24 h of surgery. Recently, several high-volume surgeons demonstrated the safety of same-day discharge (SDD) after RALP. The main benefits include lower costs and reduced exposure to nosocomial infections and hospital errors. The leading arguments for criticism include potential suboptimal postoperative care and the risk of missing a catastrophic event. In recent years, important advances have further strengthened the argument for SDD including more structured perioperative care, integration of single-port robotic systems, and new challenges presented by the coronavirus 2019 (COVID-19) pandemic. Here, we provide further evidence demonstrating the safety of SDD in a multi-institutional cohort of patients and review the main arguments supporting the expanded use of this approach.
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Affiliation(s)
- Srinath Kotamarti
- Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Thomas Williams
- Hofstra-Northwell School of Medicine, 450 Lakeville Rd, Suite M42, Lake Success, NY, 11042, USA
| | - Michael Silver
- Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA.,, 450 Clarkson Ave, BSB 4-32, Brooklyn, NY, 11203, USA
| | - David A Silver
- Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Ariel A Schulman
- Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA.
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Vukovic N, Dinic L. Enhanced Recovery After Surgery Protocols in Major Urologic Surgery. Front Med (Lausanne) 2018; 5:93. [PMID: 29686989 PMCID: PMC5900414 DOI: 10.3389/fmed.2018.00093] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/23/2018] [Indexed: 01/31/2023] Open
Abstract
The purpose of the review The analysis of the components of enhanced recovery after surgery (ERAS) protocols in urologic surgery. Recent findings ERAS protocols has been studied for over 20 years in different surgical procedures, mostly in colorectal surgery. The concept of improving patient care and reducing postoperative complications was also applied to major urologic surgery and especially procedure of radical cystectomy. This procedure is technically challenging, due to a major surgical resection and high postoperative complication rate that may reach 65%. Several clinical pathways were introduced to improve perioperative course and reduce the length of hospital stay. These protocols differ from ERAS modalities in other surgeries. The reasons for this are longer operative time, increased risk of perioperative transfusion and infection, and urinary diversion achieved using transposed intestinal segments. Previous studies in this area analyzed the need for mechanical bowel preparation, postoperative nasogastric tube decompression, as well as the duration of urinary drainage. Furthermore, the attention has also been drawn to perioperative fluid optimization, pain management, and bowel function. Summary Notwithstanding partial resemblance between the pathways in major urologic surgery and other pelvic surgeries, there are still scarce guidelines for ERAS protocols in urology, which is why further studies should assess the importance of preoperative medical optimization, implementation of thoracic epidural anesthesia and analgesia, and perioperative nutritional management.
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Affiliation(s)
- Natalija Vukovic
- Anesthesiology and Reanimation Center, Clinical Center Nis, Nis, Serbia
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Abstract
BACKGROUND Enhanced recovery pathways, also known as fast-track protocols, have been adopted since the early 2000s by various surgical specialties with the goal of improving patient outcomes and reducing the cost burden of major surgery on the health care system. OBJECTIVE To review the scientific literature on the origin of enhanced recovery pathways, track the contemporary utilization of such practices for patients undergoing radical cystectomy, and analyze the available data regarding their effect on morbidity, mortality, and treatment cost. METHODS A literature search of multiple electronic databases was undertaken. Manuscripts including patients undergoing radical cystectomy were chosen based on predefined criteria with an emphasis on randomized controlled trials and cohort studies. Strength of evidence for each study that met inclusion criteria was assessed based on the risk of bias, consistency, directness, and precision. RESULTS Database searches resulted in 1,236 potentially relevant articles. A total of 485 articles were selected for full-text dual review and 106 studies in 52 publications met the inclusion criteria. CONCLUSION The utilization of enhanced recovery pathways with the goal of improving overall patient morbidity and mortality is well supported in the literature, however standardization of implementation and adherence across institutions is lacking, and their direct efficacy on reducing preventable treatment related expenditures is unconfirmed.
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Affiliation(s)
- Ian Maloney
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Daniel C. Parker
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Michael S. Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Sanjay Patel
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
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Wolboldt M, Saltzman B, Tenbrink P, Shahrour K, Jain S. Same-Day Discharge for Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy Is Safe and Feasible: Results of a Pilot Study. J Endourol 2016; 30:1296-1300. [DOI: 10.1089/end.2016.0552] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Melinda Wolboldt
- Department of Urology, University of Toledo College of Medicine, Toledo, Ohio
| | - Barbara Saltzman
- Department of Urology, University of Toledo College of Medicine, Toledo, Ohio
| | - Patrick Tenbrink
- Department of Urology, University of Toledo College of Medicine, Toledo, Ohio
| | - Khaled Shahrour
- Department of Urology, University of Toledo College of Medicine, Toledo, Ohio
| | - Samay Jain
- Department of Urology, University of Toledo College of Medicine, Toledo, Ohio
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7
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Abou-Haidar H, Abourbih S, Braganza D, Qaoud TA, Lee L, Carli F, Watson D, Aprikian AG, Tanguay S, Feldman LS, Kassouf W. Enhanced recovery pathway for radical prostatectomy: Implementation and evaluation in a universal healthcare system. Can Urol Assoc J 2015; 8:418-23. [PMID: 25553155 DOI: 10.5489/cuaj.2114] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Enhanced recovery pathways are standardized, multidisciplinary, consensus-based tools that provide guidelines for evidence-based decision-making. This study evaluates the impact of the implementation of a clinical care pathway on patient outcomes following radical prostatectomy in a universal healthcare system. METHODS Medical charts of 200 patients with prostate cancer who underwent open and minimally invasive radical prostatectomy at a single academic hospital from 2009 to 2012 were reviewed. A group of 100 consecutive patients' pre-pathway implementation was compared with 99 consecutive patients' post-pathway implementation. Duration of hospital stay, complications, post-discharge emergency department visits and readmissions were compared between the 2 groups. RESULTS Length of hospital stay decreased from a median of 3 (inter-quartile range [IQR] 4 to 3 days) days in the pre-pathway group to a median of 2 (IQR 3 to 2 days) days in the post-pathway group regardless of surgical approach (p < 0.0001). Complication rates, emergency department visits and hospital readmissions were not significantly different in the pre- and post-pathway groups (17% vs. 21%, p = 0.80; 12% vs. 12%, p = 0.95; and 3% vs. 7%, p = 0.18, respectively). These findings were consistent after stratification by surgical approach. Limitations of our study include lack of assessment of patient satisfaction, and the retrospective study design. CONCLUSIONS The implementation of a standardized, multidisciplinary clinical care pathway for patients undergoing radical prostatectomy improved efficiency without increasing complication rates or hospital readmissions.
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Affiliation(s)
| | - Samuel Abourbih
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
| | | | - Talal Al Qaoud
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, QC
| | - Deborah Watson
- Department of Nursing, McGill University Health Centre, Montreal, QC
| | - Armen G Aprikian
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
| | - Simon Tanguay
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Wassim Kassouf
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
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Fuller A, Vanderhaeghe L, Nott L, Martin PR, Pautler SE. Intravesical Ropivacaine as a Novel Means of Analgesia Post–Robot-Assisted Radical Prostatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial. J Endourol 2013; 27:313-7. [DOI: 10.1089/end.2012.0191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrew Fuller
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | | | - Linda Nott
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Paul R Martin
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Stephen E. Pautler
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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Stuart-Smith K. Hemiarthroplasty performed under transversus abdominis plane block in a patient with severe cardiorespiratory disease. Anaesthesia 2012; 68:417-20. [DOI: 10.1111/anae.12108] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 11/30/2022]
Affiliation(s)
- K. Stuart-Smith
- Department of Anaesthesia; Christchurch Hospital; Christchurch New Zealand
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