AdventHealth Global Robotics Institute, Celebration, Florida, USA.
University of Florida, Gainesville, Florida, USA.
J Endourol. 2022 Jul;36(7):934-940. doi: 10.1089/end.2021.0730.
As the coronavirus disease 2019 (COVID-19) global pandemic continues, there is increased value in performing same-day discharge (SDD) protocols to minimize viral exposure and maintain the appropriate surgical treatment for oncologic patients. In this scenario, we performed a prospective analysis of outcomes of our patients undergoing SDD protocol after robot-assisted radical prostatectomy (RARP). The SDD criteria included patients with no intraoperative complications, stable postoperative hemoglobin levels (compared with preoperative values), stable vital signs, normal urine output, ambulation with assistance and independently without dizziness, tolerance of clear liquids without nausea or vomiting, pain control with oral medication, and patient/family confidence with SDD. Patients older than 70 years, concomitant general surgery operations, multiple comorbidities, and complex procedures such as salvage surgery were excluded from our protocol. Of the 101 patients who met the criteria for SDD, 73 (72%) had an effective SDD. All SDF (same day discharge failure) patients were discharged one day after surgery. Intraoperative characteristics were not statistically different with a median operative time of 92 (81-107) 103 (91-111) minutes for SDD and SDF, respectively. Of the 28 SDF patients, the most common reasons for staying were anesthesia-related factors of nausea (35%), drowsiness (7%), patient/caregiver preference (25%), pain (14%), labile blood pressure (7%), arrhythmia (7%), and dizziness (7%). There was no significant difference in readmission rates, complication rates, or postoperative pain scores between SDD and SDF patients. In our experience, SDD for patients undergoing RARP can be safely and feasibly incorporated into a clinical care pathway without increasing readmission rates. We were effective in 72% of cases because of coordinated care between anesthetics, nursing staff, and appropriate patient selection. We also believe that incorporating pre- and postoperative patient education and assurance is crucial to minimize their exposure to COVID-19 during the surgical treatment for prostate cancer.
随着 2019 年冠状病毒病（COVID-19）全球大流行的持续，执行当日出院（SDD）方案以最大程度减少病毒暴露并为肿瘤患者提供适当的手术治疗具有更大的价值。在这种情况下，我们对接受机器人辅助根治性前列腺切除术（RARP）后行 SDD 方案的患者的结局进行了前瞻性分析。SDD 标准包括术中无并发症、术后血红蛋白水平稳定（与术前值相比）、生命体征稳定、尿量正常、辅助行走和无头晕独立行走、可耐受无恶心或呕吐的清亮液体、口服药物控制疼痛以及患者/家属对 SDD 的信心。我们的方案排除了年龄大于 70 岁、同时行普通外科手术、多种合并症和复杂手术（如挽救性手术）的患者。符合 SDD 标准的 101 例患者中，有 73 例（72%）有效实现了 SDD。所有 SDF（当日出院失败）患者均在手术后一天出院。术中特征无统计学差异，SDD 和 SDF 的中位手术时间分别为 92（81-107）分钟和 103（91-111）分钟。在 28 例 SDF 患者中，最常见的留院原因是麻醉相关因素，包括恶心（35%）、嗜睡（7%）、患者/照护者偏好（25%）、疼痛（14%）、血压不稳定（7%）、心律失常（7%）和头晕（7%）。SDD 和 SDF 患者的再入院率、并发症发生率或术后疼痛评分无显著差异。根据我们的经验，将 RARP 患者的 SDD 安全且可行地纳入临床护理路径，而不会增加再入院率。我们在 72%的病例中取得了成功，这是因为麻醉师、护理人员之间的协调以及对合适患者的选择。我们还认为，在前列腺癌手术治疗过程中，将术前和术后患者教育和保证纳入其中对于最大限度地减少他们暴露于 COVID-19 至关重要。
