MedWire News: Results of a US feasibility study show that robot-assisted radical prostatectomy (RARP) can be undertaken as an outpatient procedure with no adverse consequences for patient satisfaction or safety.
The study was prompted by the desire to shorten hospitalization in order to decrease costs and increase profits, writes the research team from the Mayo Clinic in Phoenix, Arizona.
“In a very select group of patients, this feasibility study indicates that extraperitoneal RARP can be performed as a true outpatient procedure safely, and while maintaining high patient satisfaction with proper patient education,” write Aaron Martin and colleagues.
Over a period of 5 months, 11 prostate cancer patients were proposed the idea of going home the evening of their surgery providing there were no complications during the procedure. Patients were selected based on their exceptional preoperative health status including few comorbidities and no history of bleeding diathesis.
Surgery was undertaken at the beginning of the day, by surgeons with experience of at least 100 RARPs. The conditions for discharge from hospital were an uneventful operative course, normal postoperative hemoglobin levels, a minimal drain output, and the patient could tolerate a liquid diet.
Each patient was asked to complete the validated Patient Judgment System-24 (PJS-24) to give global satisfaction scores for elements such as hospital quality and overall pain control. A group of 10 randomly selected RARP patients who stayed in hospital overnight after surgery also completed the survey to provide a comparison.
There were no significant peri-operative complications, although one patient had a bladder neck anastomotic leak resulting in extended catheter use, and all patients left the hospital the evening after their surgery.
In all, eight patients participated in the survey with a 73% response rate. The overall process score was 94.2 out of 100, and average scores on the individual PJS-24 items were all over 90.0 except for hospital billing, at 83.8. Satisfaction scores showed that 87.5% of patients were “extremely satisfied” and one patient was simply “satisfied.”
The scores did not differ significantly from those of the inpatient group.
Interestingly, 25% of the outpatients felt that their stay in hospital was too long, while the remaining 75% felt that it was just right.
“Resources are limited and our aging population continues to expand,” writes the team in the journal Urology.
“Further investigation could shorten the current recovery pathway for prostatectomy patients and decrease overall healthcare costs,” they conclude.
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