Multi-Institutional Assessment of Routine Same Day Discharge Surgery for Robot-Assisted Radical Prostatectomy

J Urol. 2020 Nov;204(5):956-961. doi: 10.1097/JU.0000000000001129. Epub 2020 May 7.


Purpose: We assessed the multi-institutional safety of same day discharge for robot-assisted radical prostatectomy within a single health care system.

Materials and methods: We included 358 patients undergoing planned same day discharge for robot-assisted radical prostatectomy at 6 French centers. Primary outcomes were same day discharge failure, and 30-day complication and readmission rates. Secondary outcomes included preoperative characteristics, perioperative parameters, Chung score and pain visual analogue scale at discharge, pathological features and followup.

Results: Mean patient age was 64.7 years. Mean operative time and blood loss were 147.5 minutes and 228 ml, respectively. Concomitant lymph node dissection and nerve sparing procedures were performed in 43% and 62% of cases, respectively. No patient required transfusion or conversion. The same day discharge failure, complication and readmission rates were 4.2%, 16.8% and 2.8%, respectively. The most frequent complications were low grade complications including urinary infection (6.4%) and ileus (2.8%). Blood loss, lymph node dissection and pain visual analogue scale were significantly correlated with same day discharge failure. Same day discharge failure was reported in 7.8% of patients with pelvic lymph node dissection compared with only 1.5% of patients who did not undergo lymph node dissection (p=0.003). ASA® score was the only factor significantly associated with postoperative complications (p=0.023). The only factor correlated with readmission was the pain visual analogue scale at discharge (p=0.017).

Conclusions: This first multi-institutional evaluation confirms the safety of same day discharge robot-assisted radical prostatectomy in a single health care system and identifies for the first time factors associated with same day discharge failure and readmission. These findings may help physicians anticipate ideal same day discharge candidates and adapt postoperative followup.

Keywords: enhanced recovery after surgery; outpatients; postoperative complications; prostatectomy; prostatic neoplasms.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Ambulatory Surgical Procedures / adverse effects*
  • Ambulatory Surgical Procedures / methods
  • Ambulatory Surgical Procedures / standards
  • Enhanced Recovery After Surgery / standards*
  • Feasibility Studies
  • France
  • Humans
  • Lymph Node Excision / adverse effects
  • Lymph Node Excision / methods
  • Lymph Node Excision / statistics & numerical data
  • Male
  • Middle Aged
  • Operative Time
  • Patient Discharge / standards
  • Patient Discharge / statistics & numerical data
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Preoperative Care / methods
  • Preoperative Care / standards
  • Prostate / surgery
  • Prostatectomy / adverse effects*
  • Prostatectomy / methods
  • Prostatectomy / standards
  • Prostatectomy / statistics & numerical data
  • Prostatic Neoplasms / surgery*
  • Robotic Surgical Procedures / adverse effects*
  • Robotic Surgical Procedures / standards
  • Robotic Surgical Procedures / statistics & numerical data
  • Time Factors
  • Treatment Outcome