Outpatient Robot-Assisted Radical Prostatectomy: Are Patients Ready for Same-Day Discharge?

PURPOSE Several case series have demonstrated the safety and feasibility of outpatient robot-assisted radical prostatectomy (RARP) in well selected patients; however, the patient perspective of this practice has not been well explored. In this study, we explored patients' perspectives on the potential barriers and benefits of outpatient RARP. MATERIALS AND METHODS We developed a multi-dimensional questionnaire to assess socioeconomic status, presence of caretaker at home, preferred transportation to the emergency room in case of chest pain or post-surgical complications, readiness for discharge at PACU, and potential barriers for discharge. In addition, patients were asked to provide an estimate of overnight hospitalization costs and their willingness to pay out of pocket expenses for their overnight stay. Patients who underwent RARP between August 1st, 2018 and April 30th, 2019 were asked to fill the questionnaire within the first week following their operation. RESULTS During our study 157/292 (53.8%) of men undergoing RARP patients from a single high-volume robotic surgeon completed the survey. Patients who completed less than 80% of the survey (n=5) were excluded from the final analysis. Thirty-seven (24.3%) patients felt that they would have been ready to be discharged immediately from PACU, and 48 (31.6%, patients after extended recovery and before midnight. Only 17.8% (n=27) of the patients claim that they experienced a medical intervention in the hospital that could not have been managed at home. The main barriers for same-day discharge were pain (55.9%, 80/143), catheter discomfort (44.7%, 64/143), insufficient education about catheter care (31.4%, 45/143), post-operative nausea and vomiting (15.3%, 22/143), and medical complications (13.2%, 19/143). CONCLUSIONS Two-thirds of patients following RARP did not feel ready to be discharged on the day of their surgery. Further research is necessary to identify patients who may benefit from this approach to reduce healthcare costs while minimizing patient postoperative morbidity.