Feasibility and Outcomes of Same-Day Discharge Following Multi-Port Robot-Assisted Radical Prostatectomy

Introduction Robot-assisted radical prostatectomy (RARP) provides much quicker recovery for men than open prostatectomy. In most centers, discharge is planned the morning after surgery. However, after several years, we observed that no routine intervention was required for a majority of men over the first evening. Here, we detail our institution's outcomes for multiport RARP (MP-RARP) with same-day discharge (SDD). Methods After excluding patients with single-port RARP (n=25) and overnight stays (n=30), data from 224 patients (n=224/279, 88.2%) who underwent MP-RARP from May 2021 to September 2023 were collected. All patients were placed on an Enhanced Recovery After Surgery protocol and were given instructions regarding SDD. Patients were considered as SDD if they were discharged on the day of surgery. Data regarding messages and phone calls to healthcare providers, urology clinic, and emergency department visits were recorded for analysis in the week post-surgery. Results The mean (±SD) operative time was 142.5 ± 25.2 minutes, with a mean (±SD) console time of 95.1 ± 25.6 minutes. The median (IQR) estimated blood loss was 50 (50 - 100) mL, and the mean (±SD) length of hospitalization was 163.2 ± 64.6 minutes. No intraoperative complications occurred in this cohort. The median (IQR) patient-reported pain score at one hour after surgery was 3.5 (0 - 7), compared to 2 (0 - 4) at discharge. Of the 145 (64.7%) patients who reported their postoperative pain management, only 50 (34.4%) endorsed using opioids, and of those, 8 (16%) were known chronic opioid users. In the week following surgery, 14 (6.3%) patients had unplanned visits to the healthcare facility. Additionally, 56 (25%) of patients contacted the clinic regarding the postoperative course during the same timeframe. Conclusions SDD after RARP is predictable and safe. SDD helps reduce the costs associated with inpatient stays without compromising surgical outcomes for patients.