Predictors of failed same-day discharge in patients undergoing robot-assisted radical prostatectomy in a Canadian universal healthcare system

Authors

  • Michael Uy Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  • Abdullah Alrumaih Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  • Matthew Fuda Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  • Raees Cassim Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  • Braden Milllan Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  • Bobby Shayegan Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada

DOI:

https://doi.org/10.5489/cuaj.8777

Keywords:

Ambulatory discharge, robot assisted radical prostatectomy, Same day discharge, Enhanced recovery after surgery, outpatient

Abstract

INTRODUCTION: Same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) has been shown to be feasible and safe. In order to improve uptake of this ambulatory model in Canada, we aimed to update our experience of SDD after RARP and identify reasons for SDD pathway non-initiation and failure in a universal healthcare system.

METHODS: A review of our prospectively collected database of patients undergoing RARP at a Canadian tertiary academic center from May 2021 to May 2023 was conducted. Binary logistic regression analysis determined predictors SDD pathway non-initiation and failure.

RESULTS: We identified 387 patients, of which 198 were initiated on the SDD pathway. Of those initiated, 104 (52.5%) were successfully discharged home on the same day. Patients who travelled distances greater than 100 km, or who had non-CPAP (continuous positive airway pressure)-compliant obstructive sleep apnea were significantly less likely to be initiated on the SDD pathway (both p<0.05). Patients who were scheduled to be the second case or later had an estimated blood loss ≥300 mL, or had a postoperative abdominal drain, were predictive of failing SDD after initiation (all p<0.05). There were similar rates of readmissions, unscheduled office visits, and emergency department presentations, when compared to the traditional inpatient model (all p>0.05).

CONCLUSIONS: SDD after RARP in a Canadian healthcare system remains feasible and safe for selected patients. Predictors of failed SDD identified in this study inform the development of future ambulatory protocols and highlight areas of need in infrastructure to increase uptake of these outpatient pathways.

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Published

2024-06-10

How to Cite

Uy, M., Alrumaih, A., Fuda, M., Cassim, R., Milllan, B., & Shayegan, B. (2024). Predictors of failed same-day discharge in patients undergoing robot-assisted radical prostatectomy in a Canadian universal healthcare system. Canadian Urological Association Journal, 18(10), 316–20. https://doi.org/10.5489/cuaj.8777

Issue

Vol. 18 No. 10 (2024): CUAJ October

Section

Original Research

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