Same-day discharge more preferable than inpatient RARP

Most patients prefer same-day discharge (SDD) over inpatient robotic-assisted radical prostatectomy (RARP) because of its cost-effectiveness, reports a study. The SDD approach maintains similar satisfaction levels and has comparable rates of complications across institutions and differing surgeon experience.

“These data provide evidence that SDD RARP improves value-based care with comparable outcomes at significantly lower healthcare costs,” the researchers said. “It should be the preferred approach for appropriately selected patients.”

This study compared a total of 392 consecutive RARPs performed as SDD (n=206) or inpatient (n=186) from February 2020 to November 2022 at two academic medical centres. The researchers assessed the impact of SDD vs inpatient RARP on 30-day complications using propensity score analysis.

Additionally, the total costs of RARP care were compared between the two approaches via time-driven activity-based costing analysis. Then, the researchers compared satisfaction scores using a validated Patient Satisfaction Outcome Questionnaire.

Patients who underwent inpatient RARP tended to be older, Black or Hispanic, and had higher American Society Anesthesiologists classification. The SDD RARP group had lower complications rates than the inpatient RARP group, but this did not reach statistical significance (odds ratio [OR], 0.87, 95 percent confidence interval [CI], 0.35‒2.21; p=0.8). [J Urol 2023;210:856-864]

Overall cost was lower by $2,106 (19 percent) with SDD vs inpatient RARP. In addition, median satisfaction survey scores did not significantly differ between the two groups.

“These findings confirm studies highlighting comparable safety and outcomes of SDD RARP, but our study is the first to also compare patient satisfaction using a validated instrument as well as healthcare costs, using the most accurate methodology,” the researchers said. [Urol Open Sci 2022;36:23-25; J Urol 2020;204:956-961; Urol 2019;202:959-963]

A recent study of 258 SDD and 1,290 inpatient RARPs found no significant between-group difference in terms of early postoperative morbidity (3.1 percent vs 4.7 percent; relative risk [RR], 0.65, 95 percent CI, 0.32‒1.35), reoperation (2.3 percent vs 0.6 percent; RR, 1.82, 95 percent CI, 0.63‒5.28), and readmission rates (2.6 percent vs 3.9 percent; RR, 0.5, 95 percent CI, 0.30‒1.55). [Urol Oncol 2020;38:3.e1-3.e6]

The same study showed that >70 percent of SDDs were carried out after 2012, indicating the increasing popularity of this approach over time. Another study also reported a 65-percent preference for SDD RARP. Patients of the current study, on the other hand, preferred SDD at a higher rate. [Urol Oncol 2020;38:3.e1-3.e6; Urol 2019;202:959-963]

“We surmise that during the COVID-19 pandemic, patients may have become more wary of the risk of nosocomial infections, resulting in a preference to recover at home rather than in the hospital if reasonable,” the researchers said. “Additionally, as SDD RARP has become more common and normalized, more patients might be willing to choose this option.”

RARP is traditionally complemented by an inpatient hospital admission. However, the COVID-19 pandemic compelled a transition to SDD RARP in some centres to free up much-needed inpatient beds, according to the researchers.