Scuderi Simone, Scilipoti Pietro, Nocera Luigi, Longoni Mattia, Quarta Leonardo, Zaurito Paolo, Barletta Francesco, Pellegrino Francesco, de Angelis Mario, Robesti Daniele, Pellegrino Antony, Stabile Armando, Larcher Alessandro, Montorsi Francesco, Briganti Alberto, Gandaglia Giorgio
Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Urol Oncol. 2025 Apr;43(4):271.e1-271.e8. doi: 10.1016/j.urolonc.2024.11.022. Epub 2024 Dec 16.
The utility of a pelvic drain (PD) after robot-assisted radical prostatectomy (RARP) has been recently questioned. We investigated the impact of discontinuing PD placement after RARP on complications, pain, environmental benefits, and cost savings.
We identified 1,199 patients who underwent RARP with or without extended pelvic lymph node dissection from 2016 to 2023 at a referral center. Starting in 2018, PD placement was discontinued in uncomplicated RARPs. Complications were collected following the European Association of Urology (EAU) recommendations on reporting and grading. Multivariable logistic regression models (MLR) evaluated the impact of PD use on perioperative outcomes and opioid usage. The PD life cycle-associated Carbon Dioxide Equivalent Emissions (CO2e) and its economic impact were estimated.
A PD was placed in a total of 555 (46%) patients, with a decreasing rate from 94% to 18% between 2016 and 2023. The rates of any and high-grade (HG) complications were similar between patients with and without PD (29 vs. 28% and 5% vs. 6%, respectively; all P ≥ 0.2). At MLR, the PD placement was not associated with the risk of any (OR:1.09, 95%CI:0.79-1.5) or HG complications (OR 1.45, 95%CI 0.80-2.63). PD placement was associated with greater postoperative opioid usage (OR:1.58, 95%CI:1.01-2.51, P = 0.045). The CO2e spared rose from 220 in 2016 to 2,180 in 2022 and cost savings per year increased from 1,855€ in 2016 to 18,506€ in 2022.
Unnecessary PD placement should be avoided in uncomplicated RARPs to obtain environmental benefits, reduce health-related costs, and improve patients' outcomes.
机器人辅助根治性前列腺切除术（RARP）后盆腔引流管（PD）的效用最近受到质疑。我们研究了RARP后停止放置PD对并发症、疼痛、环境效益和成本节约的影响。
我们确定了2016年至2023年在一家转诊中心接受或未接受扩大盆腔淋巴结清扫术的1199例接受RARP的患者。从2018年开始，在无并发症的RARP中停止放置PD。按照欧洲泌尿外科学会（EAU）关于报告和分级的建议收集并发症。多变量逻辑回归模型（MLR）评估了使用PD对围手术期结果和阿片类药物使用的影响。估计了与PD生命周期相关的二氧化碳当量排放（CO2e）及其经济影响。
共有555例（46%）患者放置了PD，2016年至2023年期间放置率从94%降至18%。放置和未放置PD的患者中任何并发症和高级别（HG）并发症的发生率相似（分别为29%对28%和5%对6%；所有P≥0.2）。在MLR中，放置PD与任何并发症（OR：1.09，95%CI：0.79-1.5）或HG并发症（OR 1.45，95%CI 0.80-2.63）的风险无关。放置PD与术后更高的阿片类药物使用量相关（OR：1.58，95%CI：1.01-2.51，P = 0.045）。节省的CO2e从2016年的220增加到2022年的2180，每年节省的成本从2016年的1855欧元增加到2022年的18506欧元。
在无并发症的RARP中应避免不必要地放置PD，以获得环境效益、降低与健康相关的成本并改善患者的预后。
