Transition to a digital perioperative pathway for robot-assisted radical prostatectomy: impact on patient outcomes and adherence.

OBJECTIVES

To test whether prehabilitation (PreHab), delivered digitally or as digital + on-site, improves early continence after robot-assisted radical prostatectomy (RARP) vs no PreHab, and to evaluate implementation by quantifying programme uptake after transitioning from an on-site programme to a digital pathway.

PATIENTS AND

METHODS

Two-centre, high-volume, non-randomised before-after consecutive cohort over 3 years (N = 350; Control = 204; PreHab = 146). PreHab combined pelvic floor muscle training, structured education, and optimisation via a smartphone pathway with or without a 1-day class.

PRIMARY OUTCOME: 6-week continence (0-1 pad/day).

SECONDARY OUTCOMES: same-day discharge (SDD), complications (Clavien-Dindo Grade ≥III), 30-day unplanned visits and readmissions, postoperative physiotherapy, satisfaction (0-10 visual analogue scale), and continence at 6 and 12 months. Group comparisons used chi-square/Fisher's and Mann-Whitney U; multivariable logistic regression provided adjusted estimates.

RESULTS

For the PreHab vs Control cohorts: 6-week continence 84.2% vs 67.6% (P = 0.003); SDD 47.3% vs 35.3% (P = 0.025); high-grade complications 2.1% vs 7.4% (P < 0.001); mean (standard deviation) satisfaction score 9.4 (0.7) vs 8.4 (1.3) (P < 0.001). Readmissions 3.4% vs 7.8% (P = 0.086) and unplanned visits 3.4% vs 6.4% (P = 0.218) were not different. Continence remained higher with PreHab at 6 months 97.7% vs 84.3% (P < 0.001) and 12 months 99.2% vs 93.6% (P = 0.004). Adjusted analyses showed lower odds of 6-week incontinence (odds ratio 0.43, 95% confidence interval 0.22-0.85; P = 0.015). Uptake rose from 26.6% (on-site era) to 48.2% and 68.7% across successive digital periods (P < 0.001). Effects did not differ by delivery mode.

CONCLUSIONS

Prehabilitation, regardless of delivery mode, improves early continence vs no PreHab without compromising safety; digitisation increased programme uptake, indicating that digital PreHab is an effective and scalable option.