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Vangheluwe L, Legeay M, Surlemont L, Dupuis H, Defortescu G, Cornu JN, Pfister C. Clinical impact of an enhanced recovery protocol implementation for nephrectomy and radical prostatectomy. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102674. [PMID: 38944244 DOI: 10.1016/j.fjurol.2024.102674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) is a combination of multimodal pathways to improve surgical outcomes. Recommendations for radical cystectomy have been published by the ERAS society for the cystectomy but a lack of evidence is observed for urological procedures such as nephrectomy (Ne) and radical prostatectomy (RP). The aim of our study was to evaluate the impact of enhanced recovery protocol implementation for Ne ad RP at our academic institution. METHODS We performed a retrospective, monocentric, comparative analysis, pre and post implementation of an enhanced recovery protocol for patients undergoing robotic-assisted radical prostatectomy or nephrectomy (partial or total) for cancer. The primary endpoint was the mean length of stay (LOS). Secondary endpoints included 30-days readmission, postoperative complications, 90 days survival, and oncologic outcome at 6 months. RESULTS We included 264 patients between January, 2019, and December, 2020. Statistical analysis was performed separately by type of surgery. The LOS of patients included in the ERP protocol was decreased on average by 1.3 days IC95% [-2.50; -0.08], P<0.001 for nephrectomies and by 2.2 days IC95% [-3.72; -0.62] P<0.001 for prostatectomies, compared to non-ERP patients. There were no more re-admission, death or oncologic recurrence. CONCLUSION In our experience, ERP for oncological nephrectomy and prostatectomy reduced the length of stay, without increasing postoperative complications and readmission. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucie Vangheluwe
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France.
| | - Mathilde Legeay
- Service d'anesthésie réanimation, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | - Louis Surlemont
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | - Hugo Dupuis
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | | | - Jean Nicolas Cornu
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | - Christian Pfister
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
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d'Agate D, Martini A, Lesourd M, Tollon C, Loison G, Almeras C, Pradère B, Salin A, Beauval JB, Ploussard G. Patient experience and satisfaction after same-day discharge radical prostatectomy using a personalized, digital perioperative programme. World J Urol 2024; 42:378. [PMID: 38888646 PMCID: PMC11189318 DOI: 10.1007/s00345-024-05099-7] [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: 05/04/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE To assess the patient experience and satisfaction after the implementation in routine of a personalized, digital programme before and after same-day discharge (SDD) robot-assisted radical prostatectomy (RARP). METHODS The study is a pre/post-interventional, multi-surgeon, unicentre, prospective study. All consecutive patients undergoing SDD RARP were included during a 6-month period. After a pre-interventional assessment of the satisfaction rate (n = 26), all patients (n = 46) were introduced to the Betty. Care platform and followed the BETTY COACHING programme which included a specific radical prostatectomy module. The primary endpoint was patient satisfaction 6 weeks after SDD RARP. Secondary endpoints were hospital stay, readmission and complications rates, unplanned visits, and remote monitoring data. RESULTS Median age and PSA were 66 years and 7.0 ng/ml. Lymph node-dissection and nerve-sparing procedures were performed in 41.3 and 87.0% of patients, respectively. Median operative time and blood loss were 80 min and 150 ml, respectively. The 90-day rates of unplanned visits, readmission and complications were improved after the digital tool implementation (2.2, 2.2, and 8.7%, respectively). Mean satisfaction score was 9.6 out of 10 (8.0 before implementation). Median duration of pain was 2 days after discharge, with median pain intensity of 2/10. Median duration of daily active use of remote monitoring was 34 days. The urinary continence rate was 91.3% 6 weeks after surgery in the postinterventional cohort. CONCLUSIONS The implementation of a personalized, surgery-specific, digital programme combining prehabilitation, patient education, rehabilitation, patient-reported outcome measurement and remote monitoring, improves patient experience and satisfaction and could help promoting early discharge even after a major surgery.
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Affiliation(s)
- Daniele d'Agate
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
- Department of Surgical Sciences-Urology, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, University of Turin, 10126, Turin, Italy
| | - Alberto Martini
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Marine Lesourd
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Christophe Tollon
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Guillaume Loison
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Christophe Almeras
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Benjamin Pradère
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Jean-Baptiste Beauval
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Guillaume Ploussard
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France.
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Ploussard G, Kesch C, Calleris G, Buhas B, Salin A, Almeras C, Loison G, Lesourd M, Tollon C, Pradère B, Beauval JB. From an On-site Program to a Mobile App for Prehabilitation and Rehabilitation for Robotic Radical Prostatectomy: Lessons Learned from 5 Years of Experience, the COVID-19 Outbreak, and Comparison with Nationwide Data. Eur Urol Oncol 2024; 7:297-299. [PMID: 37865569 DOI: 10.1016/j.euo.2023.10.007] [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: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/23/2023]
Abstract
Prehabilitation programs play a key role in optimizing patient experiences and outcomes after surgery. However, there are few data on robot-assisted radical prostatectomy, and prehabilitation programs may be challenging to launch and maintain over time for every patient. Here we report our 5-yr experience of an on-site prehabilitation program and its impact on patient and hospital outcomes. During the study period, we observed continuous improvements in the same-day discharge rate (from 0% to 26.4%), hospital stay (from 3 to 0.9. d), costs (-63%), days out of hospital within 30 d after surgery in our center, and in comparison to contemporary nationwide data. However, despite these advantages, maintenance and diffusion of this program could be challenging owing to the absence of incentive support and lack of human resources. This led us to develop two free-access mobile apps, available on the app stores for both patients and surgeons, that include checklists, remote monitoring, and multiple educational materials aimed at simplifying the widespread use of optimized perioperative pathways. PATIENT SUMMARY: We found that a prehabilitation program before surgery can help in optimizing patient outcomes after robot-assisted removal of the prostate. We translated this program into a mobile app available for every patient.
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Affiliation(s)
| | - Claudia Kesch
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Giorgio Calleris
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Bogdan Buhas
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | - Guillaume Loison
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Marine Lesourd
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Benjamin Pradère
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
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Farraj H, Alriyalat S. Urinary Incontinence Following Robotic-Assisted Radical Prostatectomy: A Literature Review. Cureus 2024; 16:e53058. [PMID: 38410341 PMCID: PMC10896250 DOI: 10.7759/cureus.53058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Prostate cancer ranks as one of the most prevalent cancers among men in the United States, contributing significantly to cancer-related mortality. Robot-assisted radical prostatectomy (RARP) has become a cornerstone in the management of localized prostate cancer. This literature review delves into the outcomes of RARP, specifically its impact on urinary incontinence (UI) compared to other surgical methods. We also present the importance of patient perception versus medical reports. Recent studies and trials have unveiled that postoperative UI and erectile dysfunction (ED) remain common concerns following prostatectomy. However, studies have shown that RARP has lower occurrences of UI and ED compared to radical retropubic prostatectomy (RRP). While the choice of surgical method may not drastically affect these outcomes, the review emphasizes that urinary incontinence extends beyond physical symptoms. It profoundly impacts patients' psychological well-being, social interactions, and overall quality of life. Differences in symptom recording and interpretation between patients and healthcare professionals can significantly influence the diagnosis and treatment of prostate cancer. Enhanced patient-physician communication and patient-centered care are essential to providing a holistic approach to prostate cancer management. The choice of surgical methods may not significantly impact postoperative urinary incontinence and erectile dysfunction. Continued research and advancements in treatment and patient care are crucial for improving outcomes and the overall well-being of prostate cancer patients.
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Affiliation(s)
- Hamzeh Farraj
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
| | - Sulieman Alriyalat
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
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Sadri H, Fung-Kee-Fung M, Shayegan B, Garneau PY, Pezeshki P. A systematic review of full economic evaluations of robotic-assisted surgery in thoracic and abdominopelvic procedures. J Robot Surg 2023; 17:2671-2685. [PMID: 37843673 PMCID: PMC10678817 DOI: 10.1007/s11701-023-01731-7] [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: 08/11/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
This study aims to conduct a systematic review of full economic analyses of robotic-assisted surgery (RAS) in adults' thoracic and abdominopelvic indications. Authors used Medline, EMBASE, and PubMed to conduct a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Fully published economic articles in English were included. Methodology and reporting quality were assessed using standardized tools. Majority of studies (28/33) were on oncology procedures. Radical prostatectomy was the most reported procedure (16/33). Twenty-eight studies used quality-adjusted life years, and five used complication rates as outcomes. Nine used primary and 24 studies used secondary data. All studies used modeling. In 81% of studies (27/33), RAS was cost-effective or potentially cost-effective compared to comparator procedures, including radical prostatectomy, nephrectomy, and cystectomy. Societal perspective, longer-term time-horizon, and larger volumes favored RAS. Cost-drivers were length of stay and equipment cost. From societal and payer perspectives, robotic-assisted surgery is a cost-effective strategy for thoracic and abdominopelvic procedures.Clinical trial registration This study is a systematic review with no intervention, not a clinical trial.
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Affiliation(s)
- Hamid Sadri
- Department of Health Economic and Outcomes Research, Medtronic ULC, 99 Hereford St., Brampton, ON, L6Y 0R3, Canada.
| | - Michael Fung-Kee-Fung
- Champlain Regional Cancer Program Depts OB/GYN, Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, 50 Charlton Ave., Hamilton, ON, L8N 4A6, Canada
| | - Pierre Y Garneau
- Surgical Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Padina Pezeshki
- Department of Clinical Research, Medtronic ULC, 99 Hereford St., Brampton, ON, L6Y 0R3, Canada
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de Pablos-Rodríguez P, Suárez Novo JF, Castells Esteve M, Bonet Puntí X, Picola Brau N, Abella Serra A, López Picazo E, Cabrera Coma A, Sánchez Allueva A, Vigués Julià F. Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen. Actas Urol Esp 2023; 47:288-295. [PMID: 37272321 DOI: 10.1016/j.acuroe.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To report our initial experience with robotic radical prostatectomy as an outpatient procedure. MATERIAL AND METHODS Retrospective analysis of patients who underwent RRP as MAS (Major Ambulatory Surgery) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. RESULTS We identified a total of 35 patients with an average age of 60,8 ± 6,88 years and a BMI of 27 ± 2,9 Kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ± 42,15 min and the average blood loss was 301,2 ± 184,38 mL. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, seven mild postoperative complications (Clavien I-II) and one severe complication (Clavien IIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. CONCLUSION The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients.
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Affiliation(s)
- P de Pablos-Rodríguez
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain; Escuela de Doctorado de la Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain.
| | - J F Suárez Novo
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M Castells Esteve
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - X Bonet Puntí
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - N Picola Brau
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Abella Serra
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E López Picazo
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Cabrera Coma
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Sánchez Allueva
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - F Vigués Julià
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
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Mulholland C, Soliman C, Furrer MA, Sathianathen N, Corcoran NM, Schramm B, Mertens E, Peters J, Costello A, Lawrentschuk N, Dundee P, Thomas B. Same day discharge for robot-assisted radical prostatectomy: a prospective cohort study documenting an Australian approach. ANZ J Surg 2023; 93:669-674. [PMID: 36637213 DOI: 10.1111/ans.18198] [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: 03/16/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The introduction of robotic surgical systems has significantly impacted urological surgery, arguably more so than other surgical disciplines. The focus of our study was length of hospital stay - patients have traditionally been discharged day 1 post-robot-assisted radical prostatectomy (RARP), however, during the ongoing COVID-19 pandemic and consequential resource limitations, our centre has facilitated a cohort of same-day discharges with initial success. METHODS We conducted a prospective tertiary single-centre cohort study of a series of all patients (n = 28) - undergoing RARP between January and April 2021. All patients were considered for a day zero discharge pathway which consisted of strict inclusion criteria. At follow-up, each patient's perspective on their experience was assessed using a validated post-operative satisfaction questionnaire. Data were reviewed retrospectively for all those undergoing RARP over the study period, with day zero patients compared to overnight patients. RESULTS Overall, 28 patients 20 (71%) fulfilled the objective criteria for day zero discharge. Eleven patients (55%) agreed pre-operatively to day zero discharge and all were successfully discharged on the same day as their procedure. There was no statistically significant difference in age, BMI, ASA, Charlson score or disease volume. All patients indicated a high level of satisfaction with their procedure. Median time from completion of surgery to discharge was 426 min (7.1 h) in the day zero discharge cohort. CONCLUSION Day zero discharge for RARP appears to deliver high satisfaction, oncological and safety outcomes. Therefore, our study demonstrates early success with unsupported same-day discharge in carefully selected and pre-counselled patients.
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Affiliation(s)
- Clancy Mulholland
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Christopher Soliman
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Marc A Furrer
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
| | | | - Niall M Corcoran
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Belinda Schramm
- Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Evie Mertens
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Justin Peters
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Anthony Costello
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Philip Dundee
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Thomas
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
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Wang D, Hu Y, Liu K, Liu Z, Chen X, Cao L, Zhang W, Li K, Hu J. Issues in patients' experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence. BMJ Open 2023; 13:e068910. [PMID: 36810180 PMCID: PMC9945048 DOI: 10.1136/bmjopen-2022-068910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To explore patients' experiences of enhanced recovery after surgery (ERAS) and to identify issues in the implementation of ERAS from the patient's perspective. DESIGN The systematic review and qualitative analysis were based on the Joanna Briggs Institute's methodology for conducting synthesis. DATA SOURCES Relevant studies published in four databases, that is, Web of Science, PubMed, Ovid Embase and the Cochrane Library, were systematically searched, and some studies were supplemented by key authors and reference lists. STUDY SELECTION Thirty-one studies were identified, involving 1069 surgical patients enrolled in the ERAS programme. The inclusion and exclusion criteria were formulated based on the Population, Interest of phenomena, Context, Study design criteria recommended by the Joanna Briggs Institute to determine the scope of article retrieval. The inclusion criteria were as follows: ERAS patients' experiences; qualitative data; English language and published from January 1990 to August 2021. DATA EXTRACTION Data were extracted from relevant studies using the standardised data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument for qualitative research. DATA SYNTHESIS The themes in the structure dimension are as follows: (1) patients cared about the timeliness of healthcare professionals' help; (2) patients cared about the professionalism of family care; and (3) patients misunderstood and worried about the safety of ERAS. The themes in the process dimension are as follows: (1) patients needed adequate and accurate information from healthcare professionals; (2) patients needed to communicate adequately with healthcare professionals; (3) patients hoped to develop a personalised treatment plan and (4) patients required ongoing follow-up services. The theme in the outcome dimension is as follows: patients wanted to effectively improve severe postoperative symptoms. CONCLUSIONS Evaluating ERAS from the patient's perspective can reveal the omissions and deficiencies of healthcare professionals in clinical care so that problems in patients' recovery process can be solved in a timely manner, reducing potential barriers to the implementation of ERAS. PROSPERO REGISTRATION NUMBER CRD42021278631.
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Affiliation(s)
- Dan Wang
- Post-doctoral Mobile Research Station of Public Health and Preventive Medicine, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yanjie Hu
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Kai Liu
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinrong Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Liujiao Cao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Weihan Zhang
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ka Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Jiankun Hu
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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9
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de Pablos-Rodríguez P, Suárez Novo J, Castells Esteve M, Bonet Puntí X, Picola Brau N, Abella Serra A, López Picazo E, Cabrera Coma A, Sánchez Allueva A, Vigués Julià F. Resultados preliminares de la implementación de la prostatectomía radical robótica en régimen de cirugía mayor ambulatoria. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Rakovic K, Colling R, Browning L, Dolton M, Horton MR, Protheroe A, Lamb AD, Bryant RJ, Scheffer R, Crofts J, Stanislaus E, Verrill C. The Use of Digital Pathology and Artificial Intelligence in Histopathological Diagnostic Assessment of Prostate Cancer: A Survey of Prostate Cancer UK Supporters. Diagnostics (Basel) 2022; 12:1225. [PMID: 35626380 PMCID: PMC9141178 DOI: 10.3390/diagnostics12051225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/03/2022] Open
Abstract
There has been particular interest in the deployment of digital pathology (DP) and artificial intelligence (AI) in the diagnosis of prostate cancer, but little is known about the views of the public on their use. Prostate Cancer UK supporters were invited to an online survey which included quantitative and qualitative questions exploring views on the use of DP and AI in histopathological assessment. A total of 1276 responses to the survey were analysed (response rate 12.5%). Most respondents were supportive of DP (87%, 1113/1276) and of testing AI in clinical practice as a diagnostic adjunct (83%, 1058/1276). Respondents saw DP as potentially increasing workflow efficiency, facilitating research, education/training and fostering clinical discussions between clinician and patient. Some respondents raised concerns regarding data security, reliability and the need for human oversight. Among those who were unsure about AI, information was requested regarding its performance and others wanted to defer the decision to use it to an expert. Although most are in favour of its use, some are unsure, and their concerns could be addressed with more information or better communication. A small minority (<1%) are not in favour of the testing of the use of AI in histopathology for reasons which are not easily addressed.
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Affiliation(s)
- Kai Rakovic
- Institute of Cancer Sciences, University of Glasgow, Switchback Road, Glasgow G61 1QH, UK
- Department of Pathology, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
| | - Richard Colling
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (R.C.); (L.B.); (C.V.)
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | - Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (R.C.); (L.B.); (C.V.)
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Monica Dolton
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | | | - Andrew Protheroe
- Department of Oncology, University of Oxford, Roosevelt Drive, Oxford OX3 7DQ, UK;
- Oxford Cancer & Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Alastair D. Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Richard J. Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Richard Scheffer
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | - James Crofts
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | - Ewart Stanislaus
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | - Clare Verrill
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (R.C.); (L.B.); (C.V.)
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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11
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Monsen KV, Fosså SD, Myklebust TÅ, Smeland S, Dahl AA, Stensvold A. Long-term satisfaction with curative treatment and follow-up in prostate cancer survivors. Acta Oncol 2022; 61:357-362. [PMID: 35103559 DOI: 10.1080/0284186x.2021.2006775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE In a cross-sectional observational study to explore long-term satisfaction with treatment among men who had undergone radical prostatectomy (RP) or definitive pelvic radiotherapy (RT) for prostate cancer (PCa). METHODS After mean 7 years from therapy (range: 6-8), 431 PCa-survivors (RP: n = 313, RT: n = 118) completed a mailed questionnaire assessing persistent treatment-related adverse effects (AEs) (Expanded Prostate cancer Index Composite [EPIC-26]) and seven Quality indicators describing satisfaction with the health care service following a most often general practitioner (GP)-led follow-up plan. A logistic regression model evaluated the associations between long-term satisfaction and treatment modality, age, the seven satisfaction-related Quality indicators, and persistent AEs. The significance level was set at p< .05. RESULTS Four of five (81%) PCa-survivors reported long-term satisfaction with their treatment. In a multivariable model, satisfaction was positively associated with sufficient information about treatment and AEs, patient-perceived sufficient cooperation between the hospital and the GP and sufficient follow-up of AEs (ref.: insufficient). Age ≥70 years (ref.: <70) and a rising summary score within the EPIC-26 sexual domain additionally increased long-term satisfaction. The treatment modality itself (RP versus RT) did not significantly impact on satisfaction. CONCLUSIONS The majority of curatively treated PCa-survivors are satisfied with their treatment more than 5 years after primary therapy. Sufficient information, improved cooperation between the hospital specialists and the responsible GP and optimized follow-up of AEs may further increase long-term satisfaction among prostatectomized and irradiated PCa-survivors.
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Affiliation(s)
- Kari V. Monsen
- Section for Clinical Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Sophie D. Fosså
- Section for Clinical Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Tor Å. Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Sigbjørn Smeland
- Faculty of Medicine, University of Oslo, Norway
- Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Alv A. Dahl
- Section for Clinical Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Andreas Stensvold
- Division of Clinical Oncology, Østfold Hospital Trust, Kalnes, Norway
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12
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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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13
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Saouli A, Rahota RG, Ziouziou I, Elhouadfi O, Karmouni T, Elkhader K, Koutani A, Andalousi AIA, Ploussard G. Safety and feasibility of same-day discharge laparoscopic radical prostatectomy: a systematic review. World J Urol 2022; 40:1367-1375. [PMID: 35157103 PMCID: PMC8853082 DOI: 10.1007/s00345-022-03944-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging patients within 24 h, reducing costs and length of stay, and facilitating return to active life. We perform a systematic review of literature to evaluate the feasibility of SDD RP. Methods A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Embase. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. Results Based on the literature search of 509 articles, 12 (1378 patients) met the inclusion criteria (mean age: 63 years). All studies were unicentric except one. The mean SDD surgeries experience per centre was 66 cases .The means operative time and blood loss were 154 min and 126.5 ml, respectively. Mean SDD failure was 7.4%. Concomitant lymph node dissection was performed in 56.2%. The overall complication rate was 10.2% of cases; with a majority of Clavien grade I or II. Mean readmission rate after discharge was 5%. SDD generated cost reductions compared to inpatient surgery with variable differences according to the considered healthcare system. Conclusions Day-case RP is a safe and feasible strategy in selected cases with multicentre proofs of concept. Its widespread use in routine practice needs further research due to biases in patient selection. Implementation of peri-operative pathways such as ERAS and prehabilitation improves patient adherence to SDD. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-03944-1.
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Affiliation(s)
- Amine Saouli
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco.
| | | | - Imad Ziouziou
- Department of Urology, University Hospital of Agadir, Agadir, Morocco
| | - Othmane Elhouadfi
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Tarik Karmouni
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Khalid Elkhader
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Abdellatif Koutani
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Ahmed Iben Attya Andalousi
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
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14
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Rahota RG, Salin A, Gautier JR, Almeras C, Garnault V, Tollon C, Loison G, Beauval JB, Ploussard G. A prehabilitation programme implemented before robot-assisted radical prostatectomy improves peri-operative outcomes and continence recovery. BJU Int 2021; 130:357-363. [PMID: 34854212 DOI: 10.1111/bju.15666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the impact of a routine, on-site, 1-day prehabilitation (PreHab) programme on peri-operative and continence recovery after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS All 303 consecutive RARPs performed between March 2018 and February 2020 since the routine implementation of PreHab were included in our study. PreHab was carried out according to the availability of the 1-day programme before the planned date of surgery (two sessions per month including four patients per session). The PreHab programme was implemented in 165 patients (54.5%). The primary endpoint was continence recovery, strictly defined as no safety pad use at 1 and 6 months. Secondary endpoints were peri-operative variables (blood loss, operating time, length of stay, transfusion, complications, and readmission rates). Comparisons were made according to whether the PreHab pathway was applied or not (PreHab+ vs PreHab-) in univariable and multivariable models. RESULTS The PreHab pathway was implemented for a stable proportion of patients over time (54.5%). The two cohorts were comparable in terms of preoperative and pathological features (P > 0.05). Length of stay was significantly shorter in the PreHab+ group (1.3 vs 1.9 days; P = 0.001). There was a trend towards fewer complications in the PreHab+ group (P = 0.061). Use of the PreHab pathway was independently correlated with higher continence rates at 1 month (37% vs 60%; P < 0.001) and 6 months (67.4% vs 87.3%; P < 0.001), even after controlling for age, body mass index, prostate volume, type of apical reconstruction, nerve-sparing surgery and lymph node dissection. The main limitation of the study was the absence of randomization. CONCLUSIONS Our experience demonstrates that the PreHab programme is the major predictor of improved peri-operative outcomes and continence recovery after RARP, with sustainable benefits 6 months after surgery.
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Affiliation(s)
| | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | | | - Valérie Garnault
- Public Health Department, PMSI, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Guillaume Loison
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
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15
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Mitchell KAR, Brassil KJ, Rodriguez SA, Tsai E, Fujimoto K, Krause KJ, Shay LA, Springer AE. Operationalizing patient-centered cancer care: A systematic review and synthesis of the qualitative literature on cancer patients' needs, values, and preferences. Psychooncology 2020; 29:1723-1733. [PMID: 32715542 PMCID: PMC7901502 DOI: 10.1002/pon.5500] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Efficiently addressing patient priorities and concerns remains a challenge in oncology. Systematic operationalization of patient-centered care (PCC) can support improved assessment and practice of PCC in this unique care setting. This review aimed to synthesize the qualitative empirical literature exploring the National Academy of Medicine (NAM)'s PCC constructs of values, needs, and preferences among patients' during their cancer treatment experiences. METHODS A systematic review of qualitative studies published between 2002 and 2018 addressing adult patient values, needs, and preferences during cancer treatment was conducted. Medline, EMBASE, PsycINFO, and SCOPUS databases were searched on September 10, 2018. Methodological rigor was assessed using a modified version of the Evaluation Tool for Qualitative Studies. Included study findings were analyzed using line-by-line coding; and the emergent themes were compared to the National Academy of Medicine (NAM)'s PCC dimensions. RESULTS Twenty-nine primary studies were included in the synthesis. Descriptive themes for values (autonomy, being involved, family, hope, normality, and sincerity), needs (care coordination, information, privacy, support of physical well-being, emotional support (family/friends, peer, provider), and self-support), and preferences (care coordination, decision-making, information delivery, source of social support, and treatment) were identified. "Cancer care context" emerged as an important domain in which these constructs are operationalized. This thematic framework outlines PCC attributes that oncology care stakeholders can evaluate to improve patient experiences. CONCLUSIONS These findings build on previous PCC research and may contribute to the systematic assessment of patient priorities and the improvement of oncology care quality from the patient perspective.
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Affiliation(s)
- Kerri-Anne R. Mitchell
- Department of Health Behavior and Policy, Virginia
Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of
Texas Southwestern Medical Center, Dallas, Texas
| | - Edward Tsai
- Division of Public Health Sciences, Department of Surgery,
Washington University School of Medicine, St. Louis, Missouri
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences,
The University of Texas Health Science Center at Houston (UTHealth) School of Public
Health, Houston, Texas
| | - Kate J. Krause
- Research Medical Library, The University of Texas MD
Anderson Cancer Center, Houston, Texas
| | - L. Aubree Shay
- Department of Health Promotion & Behavioral Sciences,
UTHealth School of Public Health, San Antonio, Texas
| | - Andrew E. Springer
- Michael & Susan Dell Center for Healthy Living,
Department of Health Promotion & Behavioral Sciences, UTHealth School of Public
Health, Austin, Texas
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16
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Périer P, Abadie F, Dubocage C, Hébert M, Frémont N, Zoldos S, Vernezoul C, Lepraist B, Tarroux L, Ploussard G. [The role of the urology nurse in prehabilitation and same-day discharge robot-assited radical prostatectomy programs]. Prog Urol 2020; 30:964-969. [PMID: 33008717 DOI: 10.1016/j.purol.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this article is to explain the role of urology nurse in prehabilitation and same-day discharge programs for robotic radical prostatectomy. METHODS This article is based on the analysis of the literature and the experience of our center. RESULTS In order to prepare patients for outpatient surgery, urology nurse plays a key role during prehabilitation journeys. Two weeks before the operation, the healthcare teams (nurses, anesthetists, physiotherapists, etc.) organize workshops to explain to patients the operation course and post-operative care in order to allay any anxieties. Individual and group interviews, in specific workshops (compression stockings, urinary catheter, sexology) are organized in particular with urology nurse to answer all patients' questions. In association with enhanced recovery after surgery pathway, these programs improve the patient experience and satisfaction as well as peri-operative outcomes, and allows the development of an outpatient surgery program which currently represents approximately one third of surgeries. CONCLUSION The implementation of perioperative protocols including prehabilitation improves the early results of robotic total prostatectomy, but also the patient experience. The urology nurse has a key role to play during these patient education days and in the preparation, information, support and follow-up of the patient, since the prehabilitation journey until the patient leaves the outpatient clinic.
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Affiliation(s)
- P Périer
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France
| | - F Abadie
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France
| | - C Dubocage
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France
| | - M Hébert
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France
| | - N Frémont
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France
| | - S Zoldos
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France
| | - C Vernezoul
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France
| | - B Lepraist
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France
| | - L Tarroux
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France
| | - G Ploussard
- Services d'ambulatoire et d'urologie-digestif, Clinique La Croix du Sud, 52, chemin de Ribaute, 31130 Quint-Fonsegrives, France.
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17
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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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18
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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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19
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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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20
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Griffin S, McGrath L, Chesnut GT, Benfante N, Assel M, Ostrovsky A, Levine M, Vickers A, Simon B, Laudone V. Impact of caregiver overnight stay on postoperative outcomes. Int J Health Care Qual Assur 2019; 33:18-26. [PMID: 31940152 DOI: 10.1108/ijhcqa-12-2018-0282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes. DESIGN/METHODOLOGY/APPROACH This was a retrospective cohort study of patients undergoing surgery requiring overnight stay in a highly resourced free-standing oncology ambulatory surgery center. Postoperative outcomes in patients who had caregivers stay with them overnight were compared with outcomes in those who did not. All other care was standardized. Primary outcomes were postoperative length of stay, hospital readmission rates, urgent care center (UCC) visits within 30 days and perioperative complication rates. FINDINGS Among patients staying overnight, 2,462 (57 percent) were accompanied by overnight caregivers. In this group, time to discharge was significantly lower. Readmissions (though rare) were slightly higher, though the difference was not statistically significant (p=0.059). No difference in early (<30 day) complications or UCC visits was noted. Presence of a caregiver overnight was not associated with important differences in outcomes, though further research in a less well-structured environment is likely to show a more robust benefit. Caregivers are still recommended to stay overnight if that is their preference as no harm was identified. ORIGINALITY/VALUE This study is unique in its evaluation of the clinical impact of having a caregiver stay overnight with ambulatory surgery patients. Little research has focused on the direct impact of the caregiver on patient outcomes, especially in the ambulatory setting. With increased adoption of minimally invasive surgical techniques and enhanced recovery pathways, a larger number of patients are eligible for short-stay ambulatory surgery. Factors that impact discharge and early postoperative complications are important.
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Affiliation(s)
- Susan Griffin
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Leigh McGrath
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gregory T Chesnut
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicole Benfante
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Melissa Assel
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Aaron Ostrovsky
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marcia Levine
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew Vickers
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brett Simon
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vincent Laudone
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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21
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Roberts MJ, Papa N, Perera M, Scott S, Teloken PE, Joshi A, Vela I, Pryor D, Martin J, Woo H. A contemporary, nationwide analysis of surgery and radiotherapy treatment for prostate cancer. BJU Int 2019; 124 Suppl 1:31-36. [DOI: 10.1111/bju.14773] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Matthew J. Roberts
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Nepean Urology Research Group; Kingswood NSW Australia
| | - Nathan Papa
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Marlon Perera
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Susan Scott
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
| | - Patrick E. Teloken
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Andre Joshi
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - Ian Vela
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - David Pryor
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | | | - Henry Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
- Department of Uro-Oncology; Chris O'Brien Lifehouse; Sydney NSW Australia
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22
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Lawrentschuk N. Rare and less common tumours: urologists at the forefront of testicular and penile cancer. BJU Int 2019; 123 Suppl 5:4-5. [PMID: 31116004 DOI: 10.1111/bju.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Nathan Lawrentschuk
- University of Melbourne, Melbourne, VIC, Australia.,Department of Surgery, Austin Hospital and Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC, Australia
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23
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Ahn T, Roberts MJ, Strahan A, Malone G, Paterdis J, Wood G, Heathcote P. Improved lower urinary tract symptoms after robot-assisted radical prostatectomy: implications for survivorship, treatment selection and patient counselling. BJU Int 2019; 123 Suppl 5:47-53. [DOI: 10.1111/bju.14717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Ahn
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
| | - Matthew J. Roberts
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Department of Urology; Princess Alexandra Hospital; Brisbane Qld Australia
| | - Andrew Strahan
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
| | - Greg Malone
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Department of Urology; Princess Alexandra Hospital; Brisbane Qld Australia
- Brisbane Urology Clinic; Brisbane Qld Australia
| | - Jason Paterdis
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Brisbane Urology Clinic; Brisbane Qld Australia
- Department of Urology; QEII Jubilee Hospital; Brisbane Qld Australia
| | - Glen Wood
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Brisbane Urology Clinic; Brisbane Qld Australia
| | - Peter Heathcote
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Department of Urology; Princess Alexandra Hospital; Brisbane Qld Australia
- Brisbane Urology Clinic; Brisbane Qld Australia
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24
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Mukherjee K, Kamal KM. Variation in prostate surgery costs and outcomes in the USA: robot-assisted versus open radical prostatectomy. J Comp Eff Res 2019; 8:143-155. [PMID: 30620207 DOI: 10.2217/cer-2018-0109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To compare perioperative complications, inpatient cost and length of stay between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) using National Inpatient Sample data from 2010 to 2015. PATIENTS & METHODS A total of 69,009 records with RARP or ORP were analyzed using multivariate logistic regression and generalized linear models. RESULTS The RARP had superior perioperative outcomes at a higher cost (adjusted mean difference = 2956; 95% CI: $2822-$3090) and shorter length of stay (mean difference = 0.85; 95% CI: 0.81-0.89) compared with ORP. Mean cost of RARP was lowest in urban teaching, private invest-own, high volume and northeast region hospitals and highest for black men. CONCLUSION Compared with ORP, RARP had significantly better perioperative outcomes at a higher cost.
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Affiliation(s)
- Kumar Mukherjee
- Department of Pharmacy Practice, Philadelphia College of Osteopathic Medicine, School of Pharmacy, Suwanee, GA, 30024, USA
| | - Khalid M Kamal
- Duquesne University School of Pharmacy, Division of Pharmaceutical, Administrative & Social Sciences, Pittsburgh, PA, 15282, USA
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25
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Zeps N, Davis ID, Mark S. Good clinical practice can and must include comparative effectiveness research. BJU Int 2018; 122 Suppl 5:7-8. [DOI: 10.1111/bju.14590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nik Zeps
- Epworth HealthCare; Box Hill Vic Australia
- Monash University Eastern Health Clinical School; Box Hill Vic Australia
| | - Ian D. Davis
- Monash University Eastern Health Clinical School; Box Hill Vic Australia
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26
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Gielchinsky I, Chang J, Cusick T, Delprado W, Nguyen Q, Yuen C, Savdie R, Böhm M, Haynes AM, Scheltema MJ, Stricker PD. Prostate cancer in 432 men aged <50 years in the prostate-specific antigen era: a new outlook. BJU Int 2018; 122 Suppl 5:35-41. [DOI: 10.1111/bju.14586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ilan Gielchinsky
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - John Chang
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Thomas Cusick
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Warick Delprado
- Douglass Hanly Moir Pathology; Macquarie Park NSW Australia
- School of Medicine; University of New South Wales; Kensington NSW Australia
| | - Quoc Nguyen
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Carlo Yuen
- School of Medicine; University of New South Wales; Kensington NSW Australia
- St Vincent's Clinic; Sydney NSW Australia
| | - Richard Savdie
- School of Medicine; University of New South Wales; Kensington NSW Australia
- St Vincent's Clinic; Sydney NSW Australia
| | - Maret Böhm
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Matthijs J. Scheltema
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Phillip D. Stricker
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- School of Medicine; University of New South Wales; Kensington NSW Australia
- St Vincent's Clinic; Sydney NSW Australia
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27
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Mühlstädt S, Friedl A, Zachoval R, Mohammed N, Schumann A, Theil G, Fornara P. An overview of the ATOMS generations: port types, functionality and risk factors. World J Urol 2018; 37:1679-1686. [DOI: 10.1007/s00345-018-2548-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/25/2018] [Indexed: 11/29/2022] Open
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