Ali Sohrab Naushad, Khanmammadova Narmina, Myklak Kristene, Afyouni Andrew Shea, Jiang Daniel, O'Leary Mitchell, Sanavi Andre, Gao Ashley, Chu Timothy, Gomez Ralph Kevin Medina, Nguyen Tuan Thanh, Fung Catherine, Nguyen Caroline, Shahait Mohammed, Lee David I
Department of Urology, University of California, Irvine, California, USA.
Department of Urology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam.
J Endourol. 2024 Dec;38(12):1346-1352. doi: 10.1089/end.2024.0497. Epub 2024 Sep 26.
Robot-assisted radical prostatectomy (RARP) provides much quicker recovery for men than open prostatectomy. In most centers, discharge is planned the morning after operation. However, after several years, we observed that no routine intervention was required for a majority of men over the first evening. Here, we detail our institution's outcomes for multiport RARP (MP-RARP) with same-day discharge (SDD). After excluding patients with single-port RARP ( = 25) and overnight stays ( = 30), data from 224 patients ( = 224/279, 88.2%) who underwent MP-RARP from May 2021 to September 2023 were collected. All patients were placed on an Enhanced Recovery After Surgery protocol and were given instructions regarding SDD. Patients were considered as SDD if they were discharged on the day of operation. Data regarding messages and phone calls to health care providers, urology clinic, and emergency department visits were recorded for analysis in the week postoperation. The mean (±standard deviation [SD]) operative time was 142.5 ± 25.2 minutes, with a mean (±SD) console time of 95.1 ± 25.6 minutes. The median (interquartile range [IQR]) estimated blood loss was 50 (50-100) mL, and the mean (±SD) length of hospitalization was 163.2 ± 64.6 minutes. No intraoperative complications occurred in this cohort. The median (IQR) patient-reported pain score at 1 hour after operation was 3.5 (0-7), compared with 2 (0-4) at discharge. Of the 145 (64.7%) patients who reported their postoperative pain management, only 50 (34.4%) endorsed using opioids, and of those, 8 (16%) were known chronic opioid users. In the week after operation, 14 (6.3%) patients had unplanned visits to the health care facility. Additionally, 56 (25%) of patients contacted the clinic regarding the postoperative course during the same time frame. SDD after RARP is predictable and safe. SDD helps reduce the costs associated with inpatient stays without compromising surgical outcomes for patients.
机器人辅助根治性前列腺切除术（RARP）比开放性前列腺切除术能让男性恢复得更快。在大多数中心，计划在术后次日早晨出院。然而，几年后，我们观察到大多数男性在术后第一个晚上无需常规干预。在此，我们详细介绍了我们机构多端口RARP（MP-RARP）同日出院（SDD）的结果。排除单端口RARP患者（n = 25）和过夜住院患者（n = 30）后，收集了2021年5月至2023年9月期间接受MP-RARP的224例患者（n = 224/279，88.2%）的数据。所有患者均采用加速康复外科方案，并接受了关于同日出院的指导。如果患者在手术当天出院，则被视为同日出院。记录术后一周内患者给医疗服务提供者、泌尿外科诊所的留言和电话以及急诊就诊的数据用于分析。平均（±标准差[SD]）手术时间为142.5±25.2分钟，平均（±SD）控制台操作时间为95.1±25.6分钟。中位（四分位间距[IQR]）估计失血量为50（50 - 100）mL，平均（±SD）住院时长为163.2±64.6分钟。该队列中未发生术中并发症。术后1小时患者报告的中位（IQR）疼痛评分为3.5（0 - 7），出院时为2（0 - 4）。在报告了术后疼痛管理情况的145例（64.7%）患者中，只有50例（34.4%）认可使用阿片类药物，其中8例（16%）为已知的慢性阿片类药物使用者。术后一周内，14例（6.3%）患者非计划前往医疗机构就诊。此外，56例（25%）患者在同一时间段就术后病程联系了诊所。RARP术后同日出院是可预测且安全的。同日出院有助于降低住院相关费用，且不影响患者的手术效果。
