Nelson Bradford, Kaufman Melissa, Broughton Gregory, Cookson Michael S, Chang Sam S, Herrell S Duke, Baumgartner Roxelyn G, Smith Joseph A
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
J Urol. 2007 Mar;177(3):929-31. doi: 10.1016/j.juro.2006.10.070.
Minimally invasive surgery has been shown to decrease postoperative morbidity and length of stay for a number of surgical procedures. Furthermore, length of stay after open radical prostatectomy has decreased dramatically during the last decade. We examined differences in length of stay between a prospectively evaluated cohort of patients who underwent radical retropubic prostatectomy and robot assisted laparoscopic prostatectomy.
Between January 2003 and March 2006, 1,003 radical prostatectomies were performed at our hospital. Data were collected in prospective fashion and a comparison was made between 374 patients who underwent radical retropubic prostatectomy and 629 who underwent robot assisted laparoscopic prostatectomy. Length of stay, factors influencing length of stay, readmission rates and unscheduled clinic or emergency room visits were evaluated. Patients in the 2 groups were treated using the same clinical care pathway.
Overall 94.3% of patients in the radical retropubic prostatectomy group and 97.5% in the robot assisted laparoscopic prostatectomy group were discharged home on or before postoperative day 1. Mean length of stay in the radical retropubic and robot assisted laparoscopic prostatectomy groups was 1.25 (median 1.09) and 1.17 days (median 1.03), which was similar and not statistically different (p=0.27). Readmission rates were similar in robot assisted laparoscopic and radical retropubic prostatectomy patients (7% and 5%, respectively, p=0.12). Unscheduled clinic or emergency room visits were the same in the robot assisted laparoscopic and radical retropubic prostatectomy groups (10%, p=0.95).
Patients who underwent radical retropubic prostatectomy or robot assisted laparoscopic prostatectomy can be treated on the same clinical pathway. A targeted hospital discharge date of postoperative day 1 can be achieved in the majority of patients who underwent radical prostatectomy. Readmission rates or unscheduled hospital visits are necessary in a small percent of patients treated with an early discharge program, of which the majority are caused by ileus.
微创手术已被证明可降低多种手术的术后发病率和住院时间。此外，在过去十年中，开放性根治性前列腺切除术的住院时间已大幅缩短。我们研究了接受耻骨后根治性前列腺切除术和机器人辅助腹腔镜前列腺切除术的前瞻性评估队列患者之间的住院时间差异。
2003年1月至2006年3月期间，我院共进行了1003例根治性前列腺切除术。数据以前瞻性方式收集，并对374例行耻骨后根治性前列腺切除术的患者和629例行机器人辅助腹腔镜前列腺切除术的患者进行了比较。评估了住院时间、影响住院时间的因素、再入院率以及非计划门诊或急诊就诊情况。两组患者采用相同的临床护理路径进行治疗。
耻骨后根治性前列腺切除术组总体上94.3%的患者和机器人辅助腹腔镜前列腺切除术组97.5%的患者在术后第1天或之前出院回家。耻骨后根治性前列腺切除术组和机器人辅助腹腔镜前列腺切除术组的平均住院时间分别为1.25天（中位数1.09天）和1.17天（中位数1.03天），两者相似且无统计学差异（p = 0.27）。机器人辅助腹腔镜前列腺切除术患者和耻骨后根治性前列腺切除术患者的再入院率相似（分别为7%和5%，p = 0.12）。机器人辅助腹腔镜前列腺切除术组和耻骨后根治性前列腺切除术组的非计划门诊或急诊就诊情况相同（10%，p = 0.95）。
接受耻骨后根治性前列腺切除术或机器人辅助腹腔镜前列腺切除术的患者可采用相同的临床路径进行治疗。大多数接受根治性前列腺切除术的患者可在术后第1天实现目标出院日期。在一小部分早期出院计划治疗的患者中需要再入院或非计划住院就诊，其中大多数是由肠梗阻引起的。
