To assess and compare the use of same-day discharge (SDD) for robot-assisted laparoscopic prostatectomy (RALP) between the "Pre-pandemic" and "Pandemic" periods and investigate SDD impact on mortality and readmissions.
We examined data from the National Cancer Database on men receiving RALP in the "Pre-pandemic" (2018-2019) and "Pandemic" (2020) periods. We analyzed the differences in patient and hospital characteristics between SDD and non-SDD patients. Multivariable logistic regression analysis was performed to evaluate the likelihood of SDD during "Pandemic" versus "Pre-pandemic" periods. Inverse probability treatment weighting (IPTW) was utilized to assess the impact of SDD on 30-day mortality, 90-day mortality, and 30-day readmissions, adjusting for patient and hospital characteristics.
Out of 111,117 men, 8,997 (8%) received SDD. Patients with more comorbidities, non-private insurance, and high-risk prostate cancer reported lower SDD rates (p<0.001). Higher SDD rates were observed at academic facilities and those in the top RALP volume quartile (p<0.001). Patients who underwent RALP during the "Pandemic" period had increased odds of SDD compared to those receiving RALP in the "Pre-pandemic" period (aOR 1.37; 95%CI 1.31-1.45; p<0.001). When comparing SDD and non-SDD patient outcomes, after IPTW adjustment, there was no difference in the odds of 30-day mortality (aOR 0.98; 95%CI 0.47-2.01; p=0.95), 90-day mortality (aOR 1.09; 95%CI 0.60-1.97; p=0.76), or 30-day readmissions (aOR 0.90; 95%CI 0.76-1.06, p=0.21).
SDD for RALP increased steadily after pandemic. Identifying factors and necessary resources to standardize SDD for RALP will be crucial for its widespread adoption in the coming years.
Urology. 2024 Oct 22 [Epub ahead of print]
Filippo Dagnino, Muhieddine Labban, Brittany Berk, Zhiyu Qian, Daniel Stelzl, Hanna Zurl, Stephan Korn, Giovanni Lughezzani, Nicolò M Buffi, Alexander P Cole, Adam S Kibel, Quoc-Dien Trinh, Kathy G Niknejad
Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University - Milan, Italy. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Medical University of Graz, Graz, Austria. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: ., Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University - Milan, Italy. Electronic address: ., Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University - Milan, Italy. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ., Department of Urology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: .