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

PURPOSE: To assess the multi-institutional safety of same day discharge (SDD) for robot-assisted radical prostatectomy (RARP) within a single health care system. MATERIALS AND METHODS: We included 358 patients undergoing planned SDD for RARP in 6 French centres. Primary outcomes were SDD failure, 30-day complication and readmission rates. Secondary outcomes included pre-operative characteristics, peri-operative parameters, Chung score and pain visual analogue scale (VAS) at discharge, pathological features, follow-up. RESULTS AND LIMITATIONS: Mean patient age was 64.7 years. Mean operative time and blood loss were 147.5 minutes and 228 ml. Concomitant lymph node dissection and nerve-sparing procedures were performed in 43% and 62% of cases. No patient required transfusion or conversion. The SDD 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 VAS were significantly correlated with SDD failure. SDD 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). The ASA score was the only factor significantly associated with post-operative complications (p=0.023). The only factor correlated with readmission was the pain VAS at discharge (p=0.017). CONCLUSIONS: This first multi-institutional evaluation confirms the safety of SDD RARP in a single health care system and identifies for the first time factors associated with SDD failure and readmission. These findings may help physician for anticipating ideal SDD candidates and for adapting post-operative follow-up.