Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy.
Urol Oncol. 2023 Aug;41(8):354.e19-354.e26. doi: 10.1016/j.urolonc.2023.05.013. Epub 2023 Jun 5.
To report the trends, predictors, and patient outcomes of same-day discharge (SDD) versus non-SDD for robot-assisted laparoscopic radical prostatectomy (RALP).
We queried our centralized data warehouse to identify men with prostate cancer who underwent RALP between January 2020 and May 2022. Patient demographics and clinical characteristics were compared between SDD and non-SDD. Then, we examined the utilization of SDD in a univariable logistic regression. Then, we fitted a logistic regression model to identify the predictors of SDD. To examine the safety profile of SDD, an inverse probability of treatment weighting (IPTW) adjusted logistic regression was fitted to examine the effect of SDD on 30-day postoperative complications and readmissions.
Overall, 1,153 patients underwent RALP, of which 224 (19.4%) were SDD. The proportion of SDD increased from 4.4% in the fourth quarter of 2020 to 45% in the second quarter of 2022 (p < 0.01). The predictors of SDD were the facility where the surgery was performed (OR: 1.57; 95%CI [1.08-2.28]; p = 0.02) and whether a high-volume surgeon performed it (OR: 1.96; 95%CI [1.09-3.54]; p = 0.03). After IPTW, SDD compared to non-SDD was not associated with a difference in complications (OR: 1.07; 95%CI [0.38-2.95]; p = 0.90) or readmissions (OR: 1.22; 95%CI [0.40-3.74]; p = 0.72).
In our health system, the use of SDD is safe and currently composes of half of our RALP volume. With the advent of the hospital-at-home services, we anticipate that almost all our RALP cases will be SDD.
报告机器人辅助腹腔镜前列腺根治术（RALP）中当天出院（SDD）与非 SDD 的趋势、预测因素和患者结局。
我们查询了我们的集中数据仓库，以确定在 2020 年 1 月至 2022 年 5 月期间接受 RALP 的前列腺癌患者。比较 SDD 与非 SDD 患者的人口统计学和临床特征。然后，我们在单变量逻辑回归中检查 SDD 的利用情况。然后，我们拟合逻辑回归模型以确定 SDD 的预测因素。为了检查 SDD 的安全性，我们拟合了逆概率治疗加权（IPTW）调整后的逻辑回归，以检查 SDD 对 30 天术后并发症和再入院的影响。
总体而言，1153 名患者接受了 RALP，其中 224 名（19.4%）为 SDD。SDD 的比例从 2020 年第四季度的 4.4%增加到 2022 年第二季度的 45%（p < 0.01）。SDD 的预测因素是手术所在机构（OR：1.57；95%CI [1.08-2.28]；p=0.02）和高容量外科医生是否进行手术（OR：1.96；95%CI [1.09-3.54]；p=0.03）。在 IPTW 后，与非 SDD 相比，SDD 与并发症（OR：1.07；95%CI [0.38-2.95]；p=0.90）或再入院（OR：1.22；95%CI [0.40-3.74]；p=0.72）无关。
在我们的医疗体系中，SDD 的使用是安全的，目前构成了我们 RALP 量的一半。随着家庭医院服务的出现，我们预计几乎所有的 RALP 病例都将是 SDD。
