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机器人辅助根治性前列腺切除术的同日出院与住院手术:一项比较研究。

Same Day Discharge versus Inpatient Surgery for Robot-Assisted Radical Prostatectomy: A Comparative Study.

作者信息

Rahota Razvan George, Salin Ambroise, Gautier Jean Romain, Almeras Christophe, Loison Guillaume, Tollon Christophe, Beauval Jean Baptiste, Ploussard Guillaume

机构信息

Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France.

出版信息

J Clin Med. 2021 Feb 9;10(4):661. doi: 10.3390/jcm10040661.

Abstract

(1) Background: no study has compared outcomes of same day discharge (SDD) versus inpatient robot-assisted radical prostatectomy (RARP) in homogenous cohorts. Our aim was to compare perioperative outcomes and urinary continence recovery between SDD and inpatient RARP in contemporary, comparable patients. (2) Methods: we included consecutive patients undergoing RARP between 2018 and 2020 ( 376). Only patients eligible for SDD (no oral anticoagulant, distance home-hospital <150 km) and having >6-month follow-up were included ( = 180). All patients underwent RARP with or without lymph node dissection. Comparisons were performed between SDD ( 42) and inpatient RARP ( 138). Primary outcomes were 90-day complication and readmission rates and continence rates at 1 and 6 months. (3) Results: median patient age was 66.7 years. Median duration of surgery and blood loss was 134 min and 200 mL, respectively. Lymph node dissection and nerve-sparing procedures were performed in 76.7% and 82.2% of cases, respectively. Median follow-up was 19.5 months. No difference was seen regarding patient features, peri-operative outcomes, and pathology parameters between both groups. The proportion of SDD RARP was stable over time (23.5%). The 90-day unplanned visits, readmission and complication rates were 9.5%, 7.1%, and 19.0% in SDD patients versus 14.5% ( = 0.407), 10.1% ( = 0.560), 28.3% ( = 0.234) for inpatient RARP, respectively. Trends favoring SDD were not statistically significant. Continence rates at 1-( = 0.589) and 6-months ( = 0.674) were comparable between SDD and inpatient RARP. The main limitation was the lack of randomization. (4) Conclusions: this multi-surgeon comparative study confirms the safety of routine SDD RARP in terms of perioperative and functional outcomes. Trends favoring SDD in terms of complications, emergency visits and readmission have to be confirmed.

摘要

(1) 背景:尚无研究在同质化队列中比较当日出院(SDD)与住院机器人辅助根治性前列腺切除术(RARP)的结局。我们的目的是比较当代可比患者中SDD与住院RARP的围手术期结局及尿失禁恢复情况。(2) 方法:我们纳入了2018年至2020年间连续接受RARP的患者(376例)。仅纳入符合当日出院条件(未服用口服抗凝剂,家到医院距离<150公里)且随访时间>6个月的患者(n = 180)。所有患者均接受了有或无淋巴结清扫的RARP。对当日出院组(42例)和住院RARP组(138例)进行比较。主要结局为90天并发症、再入院率以及1个月和6个月时的尿失禁率。(3) 结果:患者中位年龄为66.7岁。中位手术时间和失血量分别为134分钟和200毫升。分别有76.7%和82.2%的病例进行了淋巴结清扫和保留神经手术。中位随访时间为19.5个月。两组在患者特征、围手术期结局和病理参数方面未见差异。当日出院RARP的比例随时间保持稳定(23.5%)。当日出院患者的90天非计划就诊、再入院和并发症发生率分别为9.5%、7.1%和19.0%,而住院RARP患者分别为14.5%(P = 0 .407)、10.1%(P = 0.560)、28.3%(P = 0.234)。倾向于当日出院的趋势无统计学意义。当日出院和住院RARP在1个月(P =0.589)和6个月(P = 0.674)时的尿失禁率相当。主要局限性是缺乏随机分组。(4) 结论:这项多外科医生的比较研究证实了常规当日出院RARP在围手术期和功能结局方面的安全性。在并发症、急诊就诊和再入院方面倾向于当日出院的趋势有待证实。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1305/7914654/2eedded78e54/jcm-10-00661-g001.jpg

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