Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Urol Pract. 2022 Jul;9(4):294-305. doi: 10.1097/UPJ.0000000000000305. Epub 2022 Mar 14.
Same-day discharge (SDD) following robot-assisted radical prostatectomy (RARP) is emerging as the standard of care. We conducted a systematic review and meta-analysis to evaluate the differences in perioperative characteristics, complication/readmissions rates and satisfaction/cost data between inpatient (IP) RARP and SDD RARP.
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was prospectively registered with PROSPERO (CRD42021258848). A comprehensive search of PubMed®, Embase®, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and conference abstract publications was performed. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias.
A total of 14 studies were included with a pooled population of 3,795 patients, including 2,348 (61.9%) IP RARPs and 1,447 (38.1%) SDD RARPs. SDD pathways varied, though many commonalities were present in patient selection, perioperative recommendations and postoperative management. When compared to IP RARP, SDD RARP had no differences in ≥grade 3 Clavien-Dindo complications (RR: 0.4, 95% CI 0.2, 1.1, p=0.07), 90-day readmission rates (RR: 0.6, 95% CI 0.3, 1.1, p=0.10) or unscheduled emergency department visits (RR: 1.0, 95% CI 0.3, 3.1, p=0.97). Cost savings per patient ranged between $367 and $2,109, and overall satisfaction was high at 87.5%-100%.
SDD following RARP is both feasible and safe, while potentially offering health care cost savings with high patient satisfaction rates. Data from this study will inform the uptake and development of future SDD pathways in contemporary urological care such that it may be offered to a broader patient population.
机器人辅助根治性前列腺切除术（RARP）后的当日出院（SDD）正在成为标准治疗方法。我们进行了系统评价和荟萃分析，以评估住院患者（IP）RARP 和 SDD RARP 之间围手术期特征、并发症/再入院率和满意度/成本数据的差异。
本研究按照系统评价和荟萃分析首选报告项目的规定进行，并在 PROSPERO（CRD42021258848）上进行了前瞻性注册。对 PubMed®、Embase®、Cochrane 中央对照试验注册中心、ClinicalTrials.gov 和会议摘要出版物进行了全面搜索。进行了一项剔除一个研究的敏感性分析，以控制异质性和偏倚风险。
共纳入 14 项研究，共有 3795 例患者，其中 2348 例（61.9%）为 IP RARP，1447 例（38.1%）为 SDD RARP。SDD 途径各不相同，但在患者选择、围手术期建议和术后管理方面存在许多共同之处。与 IP RARP 相比，SDD RARP 的≥3 级 Clavien-Dindo 并发症发生率无差异（RR：0.4，95%CI 0.2，1.1，p=0.07）、90 天再入院率（RR：0.6，95%CI 0.3，1.1，p=0.10）或非计划性急诊就诊率（RR：1.0，95%CI 0.3，3.1，p=0.97）。每位患者的成本节省范围在 367 美元至 2109 美元之间，总体满意度为 87.5%-100%。
RARP 后的 SDD 既可行又安全，同时可能带来医疗保健成本节约和高患者满意度。本研究的数据将为当代泌尿外科护理中未来 SDD 途径的采用和发展提供信息，以便为更广泛的患者群体提供服务。
